JP6826521B2 - Laser transmission lines, laser treatment tools, laser treatment equipment, and laser treatment systems - Google Patents

Description

The present invention relates to, for example, a laser transmission line for guiding a laser beam, a laser treatment tool having a laser chip attached to the tip of the laser transmission line, a laser treatment device provided with the laser treatment tool, and a laser treatment system.

In recent years, in the medical and dental fields, the development of treatment methods that place less burden on patients has been progressing. For example, surgical or medical treatment using an endoscope is performed as minimally invasive medical treatment. In particular, endoscopic submucosal dissection (Endoscopic Submucosal Dissection, abbreviated as ESD) for early gastrointestinal cancer is attracting attention as an effective treatment method with less burden on patients. Such treatment is performed using a treatment device using an electric knife or a laser.

As a laser treatment device using laser light, for example, as disclosed in Patent Document 1, it is common to provide a laser transmission path covered with a bellows-shaped exterior member on the outer circumference of a flexible fiber. .. As a result, the fiber that guides the laser light can be emitted in a desired direction, and even if the fiber is damaged, the exterior member can prevent the laser light from leaking to the outside.

However, since the laser transmission line as disclosed in Patent Document 1 has a structure in which the outer periphery of the fiber is covered with an exterior member having a bellows structure, the outer diameter of the laser transmission line is inevitably large, and this laser transmission The path could not be inserted through the device insertion slot of the endoscope. In particular, in recent years, the diameter of endoscopes has been reduced in order to reduce the burden on patients, and reducing the diameter of laser transmission lines has become a major issue.

Japanese Unexamined Patent Publication No. 2004-321464

Therefore, in view of the above problems, an object of the present invention is to provide a laser transmission line having a reduced diameter, a laser treatment device provided with the laser transmission line, and a laser treatment system.

The present invention includes a light guide member that guides a laser beam, and an exterior member that is fixed so as to be integrated with the light guide member and is made of a metal flat plate that surrounds the outer periphery of the light guide member. , is composed of a preparative attaching portion provided on a distal end side of the light guide member, the attachment portion, together with the laser chip composed of a rotationally asymmetric shape is attached to the distal end side, the outer member is the rear end side A tubular shape that is fixed, the exterior member is formed of a flexible multilayer structure, and the rear end side torque is transmitted to the front end side to rotate the laser tip so as to be arranged in a desired direction . It is characterized in that it is a laser transmission line composed of a torque transmitter.
The present invention is also characterized in that it is a laser treatment tool composed of the above-mentioned laser transmission line and a laser chip attached to the attachment portion in the laser transmission line.

The present invention is also characterized in that it is a laser treatment apparatus composed of the above-mentioned laser treatment tool and a laser oscillator connected to the other end of the laser transmission line and oscillating a carbon dioxide laser beam.
Furthermore, the present invention is characterized by being a laser treatment system composed of the above-mentioned laser treatment device and an endoscope capable of inserting the laser transmission path.

The light guide member may be solid or hollow as long as it has a transmission efficiency suitable for the laser light to be guided.
The above-mentioned fixed so as to be integrated includes a case where a part of the light guide member and the exterior member is directly or indirectly fixed. For example, when fixing the fixing member for fixing the light guide member and the exterior member, or fixing one or a plurality of points of the light guide member and the tip end, base end, or central portion of the exterior member. In this case, the fixing member for fixing the light guide member and the tip end portion of the exterior member are directly or indirectly fixed.

The torque transmitter refers to a tubular body in which a metal plate is spirally wound so as to have a multi-layer structure, and an inner layer and an outer layer are overlapped. In addition, a configuration in which the winding direction of each layer is constant and a configuration in which the winding direction is different for each layer are also included.
The metal plate includes the same or different plate width for each layer, and also includes the case where the winding pitch is the same or different.

According to the present invention, the diameter of the laser transmission line can be reduced.
More specifically, by forming the exterior member made of a flat plate metal in a multi-layer structure and surrounding the outer periphery of the light guide member, the outer diameter of the exterior member corresponding to the thickness of the metal plate can be determined. Since the outer diameter of the laser transmission line can be set, the diameter of the laser transmission line can be reduced.

In addition, even if the light guide member is damaged, the exterior member surrounding the outer periphery of the light guide member is made of metal forming a multi-layer structure, so that the light leak from the damaged portion. It is possible to prevent the laser light from being blocked by the exterior member and leaking to the outside of the laser transmission line.

Further, the by exterior member which is fixed so as to be integrated with the light guide member, it is possible to transmit the rotation of the rear end of the outer member distally, the distal end side of the light guide member Can be rotated by a desired amount of rotation, and the tip end side of the light guide member can be finely adjusted in the circumferential direction for positioning.

As a result, for example, when the assist gas is injected from the front end side of the laser transmission path or the laser chip is mounted, the rear end side is rotated to make the exterior member composed of the torque transmitter. By following and rotating the tip side, the position of the assist gas injection port and the direction of the laser chip can be finely adjusted and positioned in the circumferential direction. Therefore, the assist gas can be injected from a desired position, or the laser chip can be arranged in a desired direction.

As an aspect of the present invention, the exterior member spirally winds and covers the outer periphery of the light guide member, and the outer circumference of the first layer is spirally wound in the direction opposite to that of the first layer. It may be composed of the second layer of.
In the first layer and the second layer, for example, when flat metal plates are lined up in a predetermined coil gap, or the metal plates forming the first layer and the second layer form a plane along the longitudinal direction. This includes the case where the metal plates forming the first layer and the second layer are overlapped in the front-rear direction along the longitudinal direction, and the first layer and the second layer do not necessarily have the same configuration. There is no need.

According to the present invention, the torque generated by the rotation operation performed on the rear end side of the laser transmission line can be reliably transmitted to the front end side.
For example, when the laser transmission line is rotated in the same positive direction as the direction in which the first layer is wound on the rear end side of the laser transmission line, the first layer is tightened with respect to the light guide member. Therefore, torque in the positive direction can be transmitted to the tip of the laser transmission line. On the other hand, when the laser transmission line is rotated in the direction opposite to the direction in which the first layer is wound on the rear end side of the laser transmission line, the first layer loosens with respect to the light guide member. However, since the second layer is tightened with respect to the light guide member, torque in the opposite direction can be transmitted to the tip of the laser transmission path.
Therefore, the torque generated by the rotation operation performed on the rear end side of the laser transmission line can be reliably transmitted to the front end side.

As an aspect of the present invention, the outer peripheral surface of the exterior member may be surrounded by a resin outer layer protective member having water blocking property.
The outer layer protective member includes, for example, a resin outer protective tube, a resin coating, a heat shrink tube, and the like.

According to the present invention, when the laser transmission path is inserted into the device insertion path provided in the endoscope, the laser transmission path can be smoothly inserted into the device insertion path, and the device insertion path can be inserted. It can be prevented from being damaged.

More specifically, since the exterior member is surrounded by the resin outer layer protection member, it is possible to prevent the outer diameter of the exterior member from expanding, and the metal exterior member and the device insertion path are described above. By providing the outer layer protection member, it is possible to prevent the exterior member from being caught in the laser transmission line. Therefore, the laser transmission path can be smoothly inserted into the device insertion path, and the exterior member can prevent the device insertion path from being damaged.

Further, since the outer layer protective member has water blocking property, it is possible to prevent liquids such as physiological saline, washing water, and body fluid from entering the inside from the outside of the exterior member. As a result, it is possible to prevent the inside of the exterior member from being corroded or contaminated by the invading liquid.

Furthermore, by surrounding the outer peripheral surface of the exterior member with the outer layer protection member, it is possible to prevent the cooling water from leaking from the inside to the outside of the exterior member. Even if the light guide member is damaged, the laser light leaking from the laser transmission path absorbs the laser energy by the cooling water flowing through the cooling path, so that the outer layer protection member suppresses the deformation of the exterior member. At the same time, it is possible to prevent the laser beam from leaking to the outside.

As an aspect of the present invention, the outer layer protective member may be composed of a heat-shrinkable tube that shrinks by heating.

According to the present invention, the exterior member can be easily surrounded by the outer layer protection member, and the thickness of the outer layer protection member can be reduced. Therefore, the diameter of the laser transmission path can be reduced while having a waterproof function. it can.

Further, as an aspect of the present invention, a cooling path for passing a cooling medium along the light guide member may be provided between the light guide member and the exterior member.
The cooling medium includes distilled water, tap water, gas such as air and nitrogen gas, and a gel-like substance.

According to the present invention, the light guide member heated by the laser beam can be cooled by a cooling medium flowing through the cooling path. Therefore, it is possible to improve the durability of the laser transmission line, which can reliably treat the treatment target site with the laser beam.

Further, as an aspect of the present invention, the cooling passage is composed of a first cooling passage and a second cooling passage formed along the light guide member, and the first cooling passage and the second cooling passage are formed on the tip side. A communication unit may be provided to communicate with.

According to the present invention, the cooling medium that has flowed through one of the first cooling passage and the second cooling passage can be flowed to the other through the communication passage, so that the cooling medium can be recovered. Therefore, the cooling medium can be circulated and the hollow waveguide heated by the laser beam can be efficiently cooled. In addition, the cooling medium can be circulated in the first cooling passage or the second cooling passage without leaking to the treatment target site.

INDUSTRIAL APPLICABILITY According to the present invention, it is possible to provide a reduced diameter laser transmission line, a laser treatment apparatus provided with the laser transmission line, and a laser treatment system.

Schematic configuration diagram of a treatment system using an endoscope device and a laser treatment device. The block diagram which shows the structure of the endoscope apparatus and the laser treatment apparatus. An enlarged perspective view of a tip portion of a laser transmission line and a laser chip. An enlarged exploded perspective view of the laser chip and the tip of the laser transmission line from which the laser chip is removed. Explanatory drawing of a laser transmission line. Explanatory drawing of a laser transmission line. Explanatory drawing of the method of cutting a living tissue. An enlarged perspective view of a tip portion of a laser transmission line and a laser chip in another embodiment. An enlarged perspective view of a tip portion of a laser transmission line and a laser chip in another embodiment. Explanatory drawing of the laser transmission line in another embodiment.

An embodiment of the present invention will be described below with reference to the drawings.
FIG. 1 is a block diagram showing a schematic configuration of a laser treatment system 1 composed of an endoscope device 10 and a laser treatment device 50, and FIG. 2 is a configuration diagram showing a configuration of the endoscope device 10 and the laser treatment device 50. It is a block diagram which shows.

The laser treatment system 1 is composed of an endoscope device 10 and a laser treatment device 50. As shown in FIG. 1, the endoscope device 10 has an operator operation unit 12 connected to the device main body by a connection cable 11.
The operator operation unit 12 is mainly composed of an operation unit 13 and an endoscope tube 21.

The operation unit 13 is provided with an eyepiece portion 15, an up / down angle knob 16, a left / right angle knob 17, an operation button 18, a device insertion port 20, and the like.
The operation button 18 receives operation inputs such as air supply, water supply, suction, and zoom.

The endoscope tube 21 is provided with a flexible tube portion 22, a curved tube portion 23, and a tip component portion 30 in this order from the base portion (rear end) toward the tip end. Further, inside the endoscope tube 21, a device insertion path 19 that communicates from the device insertion port 20 to the device outlet 36 of the tip component 30 is provided. The device insertion path 19 functions as a therapeutic device insertion path for inserting a therapeutic device such as forceps or a laser transmission path 60.

In FIG. 1, the diameter is increased from the middle of the flexible tube portion 22 to the tip of the curved tube portion 23, but this is for drawing the configuration of the tip component portion 30 in an easy-to-understand manner. Actually, it has a shape with a constant diameter suitable for being inserted into a living body such as the esophagus, stomach, and intestine.

The flexible tube portion 22 has a cylindrical shape that is appropriately curved, and a therapeutic device such as an appropriate forceps can be inserted from the device insertion port 20 to the tip component portion 30. In this embodiment, a laser transmission line 60 connected to the laser treatment device 50 is inserted as a treatment device. The laser transmission line 60 constitutes the laser treatment tool 80 with the laser chip 70 assembled at the tip.
The curved pipe portion 23 is curved in the vertical direction by the operation of the vertical angle knob 16, and is curved in the horizontal direction by the left and right angle knobs 17.

The tip component 30 is provided with light guides 31, 35, an auxiliary water supply port 32, a lens 33, a nozzle 34, and a device outlet 36.
The light guides 31 and 35 are illumination portions that irradiate light that serves as illumination for imaging. This makes it possible to observe and perform treatment by illuminating the inside of the body where light does not reach.

The secondary water supply port 32 is a water supply port that discharges a liquid such as a washing water or a dyeing solution for cleaning the affected area with an endoscope or the like.
The lens 33 is a lens for collecting light from illumination such as the light guides 31 and 35 and acquiring an image to be captured, and an image sensor arranged behind the lens.

The nozzle 34 is a portion that discharges a cleaning liquid or the like for cleaning the lens 33 toward the lens 33.
The device outlet 36 is an outlet of a therapeutic device such as a laser transmission line 60 of the laser treatment device 50. The laser transmission path 60 is formed longer than the device insertion path length, which is also the total length of the endoscope tube 21. The details of the laser transmission line 60 will be described later.

As shown in FIG. 2, the endoscope device 10 is provided with an operation unit 41, a power supply unit 42, a central control unit 43, an illumination unit 44, an imaging unit 45, a water injection unit 46, and an image display unit 47. ..
The operation unit 41 transmits the operation input from the operation unit 13 (see FIG. 1) to the central control unit 43. That is, the bending operation of the curved pipe 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 operator operation unit 12, for example, an operation unit is provided in the controller main body (not shown) of the endoscope device 10 to centrally control operations such as the amount of illumination and the memory of still images. Communicate to unit 43.

The power supply unit 42 supplies operating power to each unit such as the central control unit 43, and the central control unit 43 executes various control operations for each unit.
The illumination unit 44 executes illumination from the light guides 31 and 35 (see FIG. 1).

The image pickup unit 45 captures an image transmitted from the lens 33 and an image pickup element (see FIG. 1) arranged behind the lens 33, obtains an image captured image necessary for the treatment, and performs image processing. By continuously acquiring the captured images in real time, the surgeon can perform the treatment smoothly.

The water injection unit 46 executes the injection of the liquid from the sub water supply port 32. It also executes injection of liquid from the nozzle 34. As described above, the imaging unit 45 may be provided in the vicinity of the tip component 30 or in the controller main body (not shown) of the endoscope device 10.

The image display unit 47 displays an image according to a signal transmitted from the central control unit 43. This image also includes a captured image acquired by the imaging unit 45. Therefore, the surgeon can perform the treatment while checking the captured image displayed in real time on the image display unit 47.

As shown in FIG. 2, the laser treatment device 50 includes an operation unit / display unit 51, a power supply unit 52, a central control unit 54, a guide light emitting unit 55, a laser oscillator unit 56, a cooling water discharge unit 57, and a gas discharge unit 58. It has.
The operation unit / display unit 51 receives operation inputs such as laser output settings and operation mode changes and transmits an input signal to the central control unit 54, and the central control unit 54 determines the laser output conditions and the operation status of the device. Receives the display signal of and displays appropriate information.
The power supply unit 52 supplies operating power to each unit such as the central control unit 54.

The central control unit 54 executes various control operations for each unit. The central control unit 54 includes a laser output control unit 54a, a storage unit 54b, a gas control unit 54c, and a cooling water control unit 54d.
The laser output control unit 54a controls the output value of the laser light 56a by the laser oscillation unit 56 according to the output and the operation mode set by the operation unit / display unit 51. The storage unit 54b stores appropriate data in addition to control data such as output settings and operation mode settings.

The guide light emitting unit 55 emits a guide light 55a for indicating a position where the therapeutic laser light 56a is irradiated. The guide light 55a can confirm the position where the therapeutic laser light 56a is irradiated.

The laser oscillation unit 56 oscillates the therapeutic laser beam 56a used in the treatment. In this embodiment, a carbon dioxide gas laser is used as the laser beam 56a. Operations such as setting the irradiation intensity of the carbon dioxide laser and starting and stopping the irradiation are performed by manual operation by the operation unit / display unit 51 and control output by the central control unit 54. It should be noted that a part or all of the manual operation can be replaced with a stepping operation using a foot controller (not shown) provided so as to be able to communicate and control the laser treatment device 50.
The guide light 55a emitted by the guide light emitting unit 55 and the laser light 56a oscillated by the laser oscillating unit 56 are all transmitted by one laser transmission line 60.

The cooling water discharge unit 57 supplies the cooling water 57a for cooling the hollow waveguide 62 heated by the laser beam 56a, and recovers the supplied cooling water 57a. The cooling water 57a can be circulated and supplied again after being collected. Further, in this embodiment, distilled water is used as the cooling water 57a, and the amount of the cooling water 57a released is manually operated by the operation unit / display unit 51 and controlled by the central control unit 54.
The cooling water 57a may be replaced with tap water, a gas such as air or nitrogen gas, or a gel-like substance.

The gas discharge unit 58 shown in FIG. 2 executes the discharge of the discharged gas 58a to be inserted into the laser transmission line 60. In this embodiment, compressed air is used as the released gas 58a.

Next, the structure of the laser transmission line 60 and the structure of the laser chip 70 mounted on the tip of the laser transmission line 60 will be described with reference to FIGS. 3 to 5.
FIG. 3 shows an enlarged perspective view of the tip of the laser transmission line 60, more specifically, shows an enlarged schematic perspective view of the laser transmission line 60 with the laser chip 70 attached to the tip, and FIG. 4 shows the laser chip 70 removed. An enlarged schematic perspective view of the laser transmission line 60 and the laser chip 70 is shown, and FIGS. 5 and 6 show explanatory views of the laser transmission line 60.

To elaborate on FIGS. 5 and 6, FIG. 5 (a) shows a schematic perspective view of the tip of the laser transmission line 60, and FIG. 5 (b) shows a side view of the laser transmission line 60 in FIG. 5 (a). Shown. In addition, in FIGS. 5A and 5B, in order to clarify the configuration of the laser transmission line 60, a part of the exterior member 64 is omitted, and a part of the hollow waveguide 62 and the outer layer tube 65 is omitted. , It is shown by a broken line to indicate the transparent state.
6 (a) shows a cross-sectional view taken along the line AA in FIG. 3, and FIG. 6 (b) shows a cross-sectional view taken along the line BB in FIG. 6 (a).

The laser transmission path 60 is a hollow tubular body formed longer than the endoscope tube 21, and as shown in FIGS. 3 to 6, a mounting portion 61 for mounting the laser chip 70 at the tip thereof and a mounting portion 61. It is composed of a hollow waveguide 62 that guides the laser beam 56a, a water channel forming tube 63 that surrounds the outer periphery of the hollow waveguide 62, an exterior member 64 that surrounds the outer periphery of the water channel forming tube 63, and an outer layer tube 65.
As shown in FIGS. 4 to 6, the mounting portion 61 has a laser chip mounting portion 61a, a tube connecting portion 61b, and an exterior member fixing portion 61c arranged side by side from the front end side to the rear end side.

The laser chip mounting portion 61a is a substantially cylindrical body fixed to the tip of the laser transmission path 60, and a screw thread 61d along the optical axis direction D is provided on the outer peripheral surface. The screw thread 61d is screwed and fixed to the screw thread 61d with a screw formed on the inner diameter of the end of the laser tip 70.
The tube connecting portion 61b is a tubular body provided at the rear end of the laser chip mounting portion 61a, and has an outer diameter that is larger than that of the laser chip mounting portion 61a and slightly smaller than the inner diameter of the device insertion path 19. ..

As shown in FIGS. 5A and 6A, the exterior member fixing portion 61c has an outer diameter substantially the same as the outer diameter of the laser chip mounting portion 61a described later, and the hollow waveguide 62 described later. It is formed of a tubular body having an inner diameter substantially the same as the outer diameter.
The mounting portion 61 configured in this way is provided with a cavity in the central portion, and the hollow waveguide 62 is fixed in the hollow portion.

As described above, the hollow waveguide 62 is a tubular body having the same outer diameter as the inner diameter of the exterior member fixing portion 61c and having the entire inner surface coated with a dielectric thin film (not shown), and has a conduction space 62a inside. Is formed, and a laser irradiation port 62b for irradiating the laser beam 56a is provided at the tip.

The tubular body constituting the hollow waveguide 62 has a smooth surface such as a glass tube, and is formed in a long shape by a material suitable for forming a reflective film such as silver and a dielectric thin film, and the dielectric thin film is COP. It is made of an appropriate material that efficiently reflects and transmits laser light, such as (cyclic olefin polymer) and polyimide.

In the present embodiment, since the inner peripheral surface of the hollow waveguide 62 is covered with a silver reflective film and a dielectric thin film, the laser light 56a conducting the inside of the hollow waveguide 62 (conduction space 62a) is transmitted with high transmission efficiency. Can be conducted with.

Since the hollow waveguide 62 configured in this way has the same outer diameter as the inner diameter of the exterior member fixing portion 61c, it can be fixed by inserting the hollow waveguide 62 into the exterior member fixing portion 61c. As a result, the tip of the hollow waveguide 62 is integrally fixed with the rear end of the laser chip mounting portion 61a, and the laser light 56a guided by the hollow waveguide 62 is irradiated from the tip of the laser chip mounting portion 61a. be able to.
In the fixed state in which the hollow waveguide 62 is fixed to the mounting portion 61, the laser irradiation port 62b is fixed in a state of slightly protruding from the tip of the laser chip mounting portion 61a (see FIG. 5B).

As shown in FIGS. 4 to 6, the water channel forming tube 63 is a long hollow tube having an inner diameter one size larger than the outer diameter of the hollow waveguide 62, and is made of a flexible resin. There is.
Further, the water channel forming tube 63 is fixed to the joint body on the rear end side (not shown), and the length in the longitudinal direction is slightly shorter than that of the hollow waveguide 62. Therefore, in a state where the hollow waveguide 62 is fixed to the exterior member fixing portion 61c, a slight space is formed between the front end side of the water channel forming tube 63 and the rear end side of the exterior member fixing portion 61c. There is. The cooling water 57a that has passed through the annular space formed between the water channel forming tube 63 and the outer periphery of the hollow waveguide 62 toward the front passes through this space, that is, the communication passage 68, toward the rear of the water channel forming tube 63. It circulates through the annular space formed on the outside and the inside of the exterior member 64 as shown by an arrow.

The exterior member 64 has a structure in which a stainless steel metal plate is spirally wound along the outer peripheral surface of the water channel forming tube 63, and the front end and the rear end are formed on the exterior member fixing portion 61c and the joint body (not shown), respectively. It is fixed. As shown in FIGS. 5A and 5B, the exterior member 64 has a first layer 64a, a second layer 64b, and a third layer 64c stacked from the inner diameter side to the outer diameter side. It is composed of.

In the first layer 64a, a long metal plate having a predetermined thickness is spirally wound clockwise from the tip to the rear end at a coil gap at a predetermined interval, and the tip is an exterior member. It is fixed to the outer peripheral surface of the fixing portion 61c. The metal plate constituting the first layer 64a has a plate thickness of about 10 μm to 100 μm.

In the second layer 64b, the same metal flat plate as the first layer 64a is spirally wound counterclockwise with coil gaps at predetermined intervals from the front end to the rear end. The front end portion and the rear end portion of the second layer 64b are fixed to the first layer 64a fixed to the outer peripheral surface of the exterior member fixing portion 61c.

In the third layer 64c, the same metal flat plate as the first layer 64a is spirally wound clockwise from the front end to the rear end with coil gaps at predetermined intervals, and the front end portion and the rear end portion are formed. Is fixed to the second layer 64b.
In the exterior member 64 configured in this way, since the first layer 64a, the second layer 64b, and the third layer 64c are spirally wound, for example, the endoscope tube 21 (laser transmission line 60) is bent. Even in this case, it is possible to cope with bending by changing the coil gap. That is, the exterior member 64 has flexibility.

Further, the first layer 64a and the third layer 64c are spirally wound so as to be clockwise when viewed from the tip, and the second layer 64b sandwiched between the first layer 64a and the third layer 64c is formed. It is wound counterclockwise.

As a result, when the rear end side of the exterior member 64 is rotated clockwise, the first layer 64a and the third layer 64c are tightened, and a clockwise torque can be transmitted to the front end side of the exterior member 64. Similarly, when the rear end side of the exterior member 64 is rotated counterclockwise, the second layer 64b is tightened, and a counterclockwise torque can be transmitted to the front end side of the exterior member 64.

The outer layer tube 65 is made of a heat-shrinkable resin that is shrunk by applying heat and has water resistance. As a result, the outer layer tube 65 can be formed in a thin film shape that matches the shape of the third layer 64c, and has water blocking property, so that the outer diameter of the laser transmission path 60 can be reduced.

In the laser transmission line 60 configured in this way, the outer peripheral surface of the hollow waveguide 62 and the inner peripheral surface of the water channel forming tube 63 are surrounded by a predetermined interval, and the hollow waveguide 62 and the water channel forming tube 63 are surrounded by a predetermined interval. A first cooling water channel 66 is formed between the two. On the other hand, the water channel forming tube 63 and the first layer 64a are also separated by a predetermined interval, and a second cooling water channel 67 through which the cooling water 57a flows is formed. The first cooling water channel 66 and the second cooling water channel 67 are connected to each other via a communication passage 68 formed by the exterior member fixing portion 61c, the hollow waveguide 62, and the first layer 64a.

The rear end sides of the first cooling water channel 66 and the second cooling water channel 67, which are connected via the communication passage 68 in this way, are each connected to the cooling water discharge unit 57 shown in FIG. 2, and the cooling water discharge unit. The cooling water 57a is supplied from the 57 to the first cooling water channel 66, and the cooling water 57a flowing through the first cooling water channel 66 flows to the second cooling water channel 67 through the communication passage 68 and again to the cooling water discharge unit 57. Will be recovered.

As shown in FIGS. 3, 4, and 6, the laser chip 70 that can be mounted on the tip of the laser transmission line 60 includes a laser transmission line mounting portion 71 that can be screwed into the mounting portion 61 and a laser transmission line mounting portion 71. It is composed of a contact portion 72 that comes into contact with the biological tissue on the tip end side of the above, and a connecting portion 73 that connects a part of the contact portion 72 and the laser transmission path mounting portion 71.

Briefly explaining the laser chip 70, the laser transmission line mounting portion 71 has a tubular shape having substantially the same outer diameter as the outer diameter of the tube connecting portion 61b and substantially the same inner diameter as the inner diameter of the laser chip mounting portion 61a. It is formed of a body, and a screw groove that can be screwed with a screw thread 61d is formed on the inner peripheral surface on the rear end side of the laser transmission path mounting portion 71 (see FIG. 6A).

The contact portion 72 is a solid substantially cylindrical shape arranged at a predetermined distance from the laser transmission path mounting portion 71 on the tip side of the laser transmission line mounting portion 71, and is larger than the laser transmission line mounting portion 71. The structure is one size smaller, and the tip is provided with a contact surface 72a that comes into contact with living tissue. The laser chip 70 including the contact portion 72 is made of stainless steel capable of absorbing the laser light 56a irradiated from the laser irradiation port 62b.
In the present embodiment, the laser chip 70 is made of stainless steel, but it may be made of, for example, another metal or a heat-resistant substance such as seramic as long as it can absorb the laser light 56a.

Since the contact portion 72 is formed with a hook portion 72b projecting toward the opening of the hollow waveguide 62, and the contact portion 72 is provided so as to face the laser irradiation port 62b of the hollow waveguide 62. It is possible to prevent the laser beam 56a from penetrating the tip.

As shown in FIGS. 3 and 4, the connecting portion 73 connecting the laser transmission line mounting portion 71 and the contact portion 72 arranged at a predetermined interval is the laser transmission line mounting portion 71 and the contact portion 72. The lower part of is connected.

More specifically, the connecting portion 73 has a chevron-shaped cross section when viewed from the irradiation direction of the laser beam. Further, the hooking portion 72b formed on the contact portion 72 can hook and hold the submucosal layer L2 and irradiate the laser beam 56a to cauterize the submucosal layer L2, so that the submucosal layer L2 can be cut.
The laser chip 70 configured in this way has a rotationally asymmetric shape with the irradiation direction of the laser beam 56a as the rotation axis.

Next, the hemostatic method used for endoscopic submucosal incision dissection (ESD) using the laser treatment system 1 will be described.
As described above, in endoscopic submucosal incision dissection (ESD) using the laser treatment system 1, bleeding may occur by irradiating the laser beam 56a. In such a case, the operator operation unit 12 in which the laser transmission path 60 equipped with the laser chip 70 is inserted into the device insertion path 19 is inserted into the body, and an image is taken by the imaging unit 45 displayed by the image display unit 47. Based on the front image of the tip component 30, the tip component 30 of the operator operation unit 12 is inserted until it reaches the treatment target site. The target site for treatment is a lumen such as the esophagus or stomach, which is an appropriate site of a living body including a human.

Then, while checking the image of the image display unit 47, the contact portion 72 is arranged at the bleeding site, and the heated contact surface 72a is bleeding by irradiating the laser beam 56a conducting the conduction space 62a of the hollow waveguide 62. Bleeding is stopped by contacting the site.

In this case, by operating the cooling water discharge unit 57, the cooling water 57a can circulate in the first cooling water channel 66 and the first cooling water channel 66, and the hollow waveguide 62 heated by the laser beam 56a is circulated by the cooling water 57a. Can be cooled. Since the first cooling water channel 66 is configured to be in contact with the outer peripheral surface of the heated hollow waveguide 62, the hollow waveguide 62 can be efficiently cooled with the cooling water 57a.

Further, the laser light 56a uses a CO ₂ laser having a large absorption rate with respect to water, and the cooling water 57a is supplied to the first cooling water channel 66 around the water channel forming tube 63. Therefore, by any chance, the hollow waveguide Even if the 62 is damaged and the laser beam 56a that guides the conduction space 62a leaks (erroneously irradiated), the outer peripheral surface of the water channel forming tube 63 is surrounded by the exterior member 64, so that the endoscope tube 21 Can prevent the occurrence of damage. Therefore, the operator operation unit 12 with high safety and reliability can be configured.

Further, by mounting the laser chip 70 on the laser transmission path 60 of the present embodiment, it is possible to safely cut the living tissue, specifically the tissue of the submucosal layer L2 in the vicinity of the affected tissue T to be peeled off.
Hereinafter, the method will be briefly described with reference to FIG. 7.

FIG. 7 shows an explanatory view showing cutting of the submucosal layer L2 using the laser chip 70, and in detail, FIG. 7A shows a state in which the laser chip 70 is arranged with respect to the submucosal layer L2 to be cut. A schematic view is shown, FIG. 7 (b) shows a schematic view of a state in which the laser chip 70 is arranged so as to be in an appropriate direction with respect to the submucosal layer L2 to be cut, and FIG. 7 (c) shows a mucous membrane on the laser chip 70. A schematic view of a state in which the lower layer L2 is arranged and irradiated with the laser beam 56a is shown.

First, the mucosal layer L1 is irradiated with a multi-point laser beam 56a so as to surround the affected tissue T to be peeled off, and a mark (marking) of the area to be cut is made. Next, hyaluronic acid H is injected into the submucosal layer L2 on the lower side of the affected tissue T to make the affected tissue T float, and laser light 56a is irradiated along the affected tissue T to incise the mucosal layer L1 (FIG. 7). See (a)).

Next, the laser transmission line 60 is pulled out from the device insertion port 20, the laser chip 70 is attached to the tip of the laser transmission line 60, and the laser transmission line 60 is inserted into the device insertion port 20 again. In this case, the arrangement direction of the laser chip 70 is not always the desired direction, and as shown in FIG. 7A, the affected tissue T to be cut is brought into contact with the laser transmission path mounting portion 71. It may be arranged in a direction that cannot be arranged between the portion 72 and the portion 72.

On the other hand, by rotating the rear end side of the laser transmission path 60 with the laser irradiation direction as the rotation axis, the laser chip 70 is rotated so as to be arranged in a desired direction as shown in FIG. 7B. Can be made to. Then, as shown in FIG. 7C, the abutting portion 72 is inserted along the incised mucosal layer L1, and the submucosal layer L2 is held by the hooking portion 72b shown in FIG. 4 using the connecting portion 73. , It can be cut by irradiating the laser beam 56a and cauterizing it.

In this way, the submucosal layer L2 was held by the hooking portion 72b as shown in FIG. 4, and while irradiating the laser beam 56a, the laser chip 70 was moved so as to cut, thereby applying tension to the tissue of the submucosal layer L2. In this state, the tissue of the submucosal layer L2 can be cut while irradiating the laser beam 56a. Therefore, the affected tissue T can be easily cut from the surrounding submucosal layer L2, and the affected tissue T can be separated.

An exterior member composed of a hollow waveguide 62 that guides the laser beam 56a and a metal flat plate that is fixed so as to be integrated with the hollow waveguide 62 and surrounds the outer periphery of the hollow waveguide 62. It is composed of 64 and a laser chip mounting portion 61a to which a laser chip 70 provided on the front end side of the hollow waveguide 62 is attached, and the exterior member 64 is formed of a flexible multilayer structure and is formed at the rear end. the laser transmission line 60 constituted by a tubular torque transmission member for transmitting the side of the torque to the tip side, can be reduced diameter to its outer diameter.

More specifically, by forming the exterior member 64 made of a flat plate metal with a multi-layer structure and surrounding the outer circumference of the hollow waveguide 62, the outer diameter of the exterior member 64 corresponding to the thickness of the metal plate is laser. It is involved as the outer diameter of the transmission line 60. That is, since the outer diameter of the laser transmission line 60 depends on the plate thickness of the exterior member 64, the diameter of the laser transmission line 60 can be reduced.

In addition, even if the hollow waveguide 62 is damaged, the laser beam leaking from the damaged portion because the exterior member 64 surrounding the outer circumference of the hollow waveguide 62 is made of metal forming a multi-layer structure. The 56a can be blocked by the exterior member 64 to prevent leakage to the outside of the laser transmission line 60.

Further, since the exterior member 64 is fixed so as to be integrated with the hollow waveguide 62, the rotation of the rear end side of the exterior member 64 can be transmitted to the front end side . Therefore, the distal end side of the hollow waveguide 62 can be rotated by a desired amount of rotation can be positioned by finely adjusting the leading end side of the hollow waveguide 62 in the circumferential direction.

Thus, such as in the case where is mounted the laser chip 70 to the mounting portion 61, by rotating the rear end, to be rotated to follow the distal end side of the exterior member 64 made of a torque transmission member It can be positioned by finely adjusting the direction of the laser chip 70 in the circumferential direction. Therefore, the arrangement of the laser chip 70 can be adjusted so as to have a desired direction.

Further, the exterior member 64 spirally winds the outer circumference of the hollow waveguide 62 to cover the first layer 64a, and the outer circumference of the first layer 64a is spirally wound in the direction opposite to that of the first layer 64a. By being composed of the layer 64b, the torque generated by the rotation operation performed on the rear end side of the laser transmission path 60 can be reliably and accurately transmitted to the front end side.

For example, when the laser transmission line 60 is rotated in the same positive direction as the direction in which the first layer 64a is wound on the rear end side of the laser transmission line 60, the first layer 64a is tightened with respect to the hollow waveguide 62. Therefore, torque in the positive direction can be transmitted to the tip of the laser transmission line 60.

On the other hand, when the laser transmission line 60 is rotated in the direction opposite to the direction in which the first layer 64a is wound on the rear end side of the laser transmission line 60, the first layer 64a loosens with respect to the hollow waveguide 62. However, since the second layer 64b is tightened with respect to the hollow waveguide 62, torque in the opposite direction can be transmitted to the tip of the laser transmission line 60. Therefore, the torque generated by the rotation operation performed on the rear end side of the laser transmission line 60 can be reliably transmitted to the front end side.

Furthermore, the outer peripheral surface of the exterior member 64 is surrounded by a resin outer layer tube 65 that has both water-stopping property and slipperiness, so that the laser transmission path 60 is inserted into the device insertion path 19 provided in the endoscope. In this case, the laser transmission path 60 can be smoothly inserted without causing a kink when the device is inserted, and the device insertion path 19 can be prevented from being damaged.

More specifically, since the outer layer tube 65 made of resin surrounds the outer layer member 64, it is possible to prevent the outer diameter of the outer member 64 from expanding, and the outer layer tube is between the metal outer layer member 64 and the device insertion path 19. At this point where the 65 is provided, the outer layer tube 65 can prevent the exterior member 64 and the laser transmission line 60 from being caught. Therefore, the laser transmission path 60 can be smoothly inserted into the device insertion path 19, and the exterior member 64 can be prevented from damaging the device insertion path 19.

Further, since the outer layer tube 65 has water blocking property, it is possible to prevent liquids such as body fluids and blood from entering from the outside to the inside of the exterior member 64. As a result, the exterior member 64 can prevent the inside from being corroded or contaminated by such a liquid that has entered.

Furthermore, by surrounding the outer peripheral surface of the exterior member 64 with the outer layer tube 65, even if the hollow waveguide 62 is damaged, the outer layer tube 65 suppresses the deformation of the exterior member 64, so that it is more reliable. It is possible to prevent the laser beam 56a from leaking to the outside.

Further, since the outer layer tube 65 is composed of a heat-shrinkable tube that contracts by heating, the exterior member 64 can be easily surrounded by the outer layer tube 65, and the thickness of the outer layer tube 65 can be reduced, so that the waterproof function can be obtained. It is possible to reduce the diameter of the laser transmission line 60 while maintaining the above.

Further, a first cooling water channel 66 for flowing cooling water 57a along the hollow waveguide 62 is provided between the hollow waveguide 62 and the exterior member 64, so that the hollow waveguide 62 heated by the laser beam 56a is provided. Can be cooled by the cooling water 57a flowing through the first cooling water channel 66. Therefore, it is possible to improve the durability of the laser transmission line 60, which can reliably treat the treatment target site with the laser beam 56a.

Furthermore, it is composed of a first cooling water channel 66 and a second cooling water channel 67 formed along the hollow waveguide 62, and a communication passage 68 communicating the first cooling water channel 66 and the second cooling water channel 67 on the tip side . Is provided, so that the cooling water 57a that has flowed through one of the first cooling water channel 66 or the second cooling water channel 67 can flow to the other through the communication passage 68, so that the cooling water 57a can be recovered. Therefore, the cooling water 57a can be circulated to efficiently cool the hollow waveguide 62 heated by the laser beam 56a. Further, the cooling water 57a can be circulated in the first cooling water channel 66 or the second cooling water channel 67 without leaking the cooling water 57a to the treatment target site.

In correspondence between the configuration of the present invention and the above-described embodiment, the light guide member of the present invention corresponds to the hollow waveguide 62, and similarly.
The mounting part corresponds to the laser chip mounting part 61a.
The torque transmitter corresponds to the exterior member 64 and
The outer layer protection member corresponds to the outer layer tube 65,
The cooling medium corresponds to the cooling water 57a and
The cooling channels correspond to the first cooling channel 66 and the second cooling channel 67.
The laser oscillator corresponds to the laser oscillator 56 and
The laser treatment device corresponds to the laser treatment device 50,
The endoscope corresponds to the endoscope device 10,
The present invention is not limited to the configuration of the above-described embodiment, and many embodiments can be obtained.

Further, since the laser light 56a uses a CO ₂ laser having a large absorption rate with respect to water and the cooling water 57a is supplied to the first cooling water passage 66 around the hollow waveguide 62, by any chance, the hollow waveguide Even if the 62 is damaged and the laser beam 56a that guides the conduction space 62a leaks (erroneous irradiation), the outer layer tube 65 and the endoscope tube 21 may be damaged due to the erroneous irradiation of the laser beam 56a. Can be prevented. Therefore, the operator operation unit 12 with high safety and reliability can be configured.

Furthermore, the cooling water 57a is supplied from the cooling water discharge unit 57 and is recovered by the cooling water discharge unit 57 through the first cooling water channel 66, the communication passage 68 and the second cooling water channel 67, that is, the cooling water 57a. Is circulated without leaking to the outside, so for example, distilled water or tap water may be used.

Further, in the present embodiment, the laser chip 70 has a rotationally asymmetric shape with the irradiation direction of the laser beam 56a as the rotation axis, but the shape of the laser chip 70 does not necessarily have to be rotationally asymmetric, as shown in FIG. 8, for example. In addition, a bullet-shaped laser chip 70x having a rotational symmetry shape may be used.

Furthermore, in the present embodiment, the laser chip 70 has a configuration in which the submucosal layer L2 is held between the laser transmission path mounting portion 71 and the abutting portion 72 and the laser beam 56a can be directly irradiated. As shown in FIG. 9, the 70 may be a laser chip 70y having a structure in which a bleeding stop 74 is provided below the contact portion 72. As a result, the laser tip 70y can be irradiated with the laser beam 56a to heat the hemostatic portion 74 and stop the bleeding.

Further, the laser tip 70 may be directly irradiated to the submucosal layer L2 without mounting the laser tip 70 on the mounting portion 61. When the laser chip 70 is not mounted on the mounting portion 61, the configuration of the mounting portion 61 can be appropriately changed to the corresponding configuration.

Further, in the present embodiment, the first layer 64a and the water channel forming tube 63 are separated from each other by a predetermined distance, and the second layer 64b is fixed, but such a configuration is not always necessary. For example, as shown in FIG. 10, the first layer 64a and the water channel forming tube 63 may be fixed, and the first layer 64a may not be brought into close contact with the second layer 64b.

Here, FIG. 10 shows an explanatory diagram of the laser transmission line 60z according to another embodiment. More specifically, FIG. 10A shows a cross-sectional view corresponding to the cross section AA in FIG. 3, and FIG. 10B shows a cross-sectional view taken along the line CC in FIG. 10A.
In the laser transmission line 60z, the same configuration as the laser transmission line 60 is given the same numbering, and the description thereof will be omitted.

Specifically, according to the example of FIG. 10, the first layer 64a surrounds the outer peripheral surface of the water channel forming tube 63 connected to the hollow waveguide 62 by the connecting portions 69 provided above and below the tip side. It is configured in. Therefore, the first layer 64a is indirectly fixed to the mounting portion 61 via the hollow waveguide 62.

With this configuration, when the rear end side of the exterior member 64 is rotated clockwise, for example, the first layer 64a and the third layer 64c are narrowed down to the inner diameter side, and the mounting portion 61 is rotated clockwise. be able to. On the other hand, since the second layer 64b loosens in the direction of spreading toward the outer diameter side, the second cooling water channel 67 through which the cooling water 57a flows from the front end side to the rear end end side is secured.

On the other hand, when the rear end side of the exterior member 64 is rotated counterclockwise, the mounting portion 61 can be rotated counterclockwise by narrowing the second layer 64b to the inner diameter side. At this time, the second layer 64b is narrowed down to the inner diameter side, but since the second layer 64b and the third layer 64c are fixed, the second cooling water channel 67 in which the cooling water 57a flows from the front end to the rear end side. Will be secured.

As described above, in the embodiment shown in FIG. 10, since the outer periphery of the water channel forming tube 63 is surrounded by the first layer 64a, the thickness of the outermost layer can be reduced and the second cooling path can be reliably secured. Therefore, the hollow waveguide 62 can be cooled while reducing the overall outer diameter of the laser transmission line 60z.

Furthermore, in the present embodiment, the first layer 64a, the second layer 64b, and the third layer 64c are wound with a predetermined coil gap so as to be flat along the hollow waveguide 62. For example, the first layer 64a, the second layer 64b, and the third layer 64c may be wound so as to partially overlap the front and rear in the longitudinal direction of the hollow waveguide 62, respectively.

Thereby, for example, even if the hollow waveguide 62 is damaged, it is possible to reliably prevent the laser beam 56a from leaking. Further, since the leakage of the laser beam 56a can be reliably prevented, the outer layer member does not need to have three layers, and may have two layers.

1 Laser treatment system 10 Endoscope device 50 Laser treatment device 56 Laser oscillation part 56a Laser light 57a Cooling water 60 Laser transmission line 61a Laser chip mounting part 62 Hollow waveguide 64 Exterior member 64a First layer 64b Second layer 65 Outer layer tube 66 First cooling water channel 67 Second cooling water channel 68 Communication part 70 Laser chip 80 Laser treatment tool

Claims (9)

A light guide member that guides laser light and
An exterior member that is fixed so as to be integrated with the light guide member and is made of a metal flat plate that surrounds the outer periphery of the light guide member.
Is composed of a preparative attaching portion provided on a distal end side of the light guide member,
A laser chip having a rotationally asymmetric shape is attached to the front end side of the attachment portion, and the exterior member is fixed to the rear end side.
The exterior member
A laser composed of a flexible multilayer structure and a tubular torque transmitter that transmits torque on the rear end side to the front end side to rotate the laser tip so as to be arranged in a desired direction. Transmission line. The exterior member
A first layer that spirally covers the outer circumference of the light guide member,
The laser transmission line according to claim 1, wherein the outer periphery of the first layer is composed of a spiral second layer wound in the direction opposite to that of the first layer. The laser transmission line according to claim 1 or 2, wherein the outer peripheral surface of the exterior member is surrounded by a water-stopping resin outer layer protective member. The laser transmission line according to claim 3, wherein the outer layer protective member is composed of a heat-shrinkable tube that shrinks by heating. The laser transmission line according to any one of claims 1 to 4, wherein a cooling path for passing a cooling medium along the light guide member is provided between the light guide member and the exterior member. The cooling path is composed of a first cooling path and a second cooling path formed along the light guide member.
The laser transmission line according to claim 5, wherein a communication portion for communicating the first cooling path and the second cooling path is provided on the tip side . The laser transmission line according to any one of claims 1 to 6.
A laser treatment tool composed of a laser chip attached to the attachment portion in the laser transmission line. The laser treatment tool according to claim 7 and
A laser treatment device composed of a laser oscillator that oscillates carbon dioxide laser light, which is connected to the other end of the laser transmission path. The laser treatment apparatus according to claim 8 and
A laser treatment system composed of an endoscope capable of inserting the laser transmission path.

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