JP7266840B2 - Endoscopic ligation device and endoscope - Google Patents

Description

The present invention relates to an endoscopic ligating device and an endoscope.

A ligature tool for endoscopes is used to ligate living tissue in a portion including a lesion under observation with an endoscope. The ligature tool includes, for example, a wire having a loop portion and a stopper for bundling the wire. An endoscope using a ligature tool is sometimes provided with a transparent cylindrical hood at its tip.

When ligating the living tissue using the ligature, the tip of the hood is brought into contact with the living tissue under observation with an endoscope. Next, the portion including the lesion is surrounded by a loop portion in the hood, and the diameter of the loop portion is reduced by adjusting the position of the stopper, thereby ligating the living tissue in the portion including the lesion (for example, Patent Document 1 and Non-Patent Document 1). See reference 1).

Japanese Patent No. 4294108

Akutsu D, et al, “Endoscopic detachable snare ligation: a new treatment method for colonic diverticular hemorrhage”, Endoscopy, 2015 Nov;47(11):1039-1042

However, with the above-mentioned ligature tool, when the body tissue including the lesion is ligated, the position of the loop may be displaced, making it difficult to ligate the lesion.

An object of one aspect of the present invention is to provide an endoscopic ligating device and an endoscope in which positional displacement of a loop portion is unlikely to occur when ligating a portion of a body tissue including a lesion.

One aspect of the present invention includes a flexible wire, a fastener that forms a ligating loop by folding and bundling the wire into a loop, and an extension that extends from the ligating loop. and wherein the fastener is displaceable in the lengthwise direction of the wire and the size of the ligation loop is determined according to the position in the lengthwise direction of the wire.

Preferably, the extension body is a linear body tied to the ligating loop.

The linear body is preferably a thread made of fiber.

Another aspect of the present invention is an endoscopic ligating device for use in an endoscope comprising an endoscope main body having an imaging section and a distal end cylinder provided at the distal end of the endoscope main body. and an operation portion for adjusting the size of the ligation loop, the operation portion having an insertion portion inserted into the endoscope main body, and the The insertion portion adjusts the size of the ligation loop by changing the relative position of the fastener with respect to the wire, and the extension body is configured to adjust the size of the ligation loop while the tip cylindrical body is in contact with the object to be ligated. and a ligating device for an endoscope having a length that reaches between the distal barrel and the object to be ligated when the ligating loop portion is placed in the distal barrel.

According to one aspect of the present invention, the positional deviation of the loop portion is less likely to occur when ligating a portion of the body tissue including the lesion.

1 is a configuration diagram of an endoscopic ligation device using the endoscopic ligature tool of the first embodiment; FIG. FIG. 4 is an explanatory diagram of a method of providing an extension body in the endoscopic ligature tool of the first embodiment; Explanatory drawing following the previous drawing. Explanatory drawing following the previous drawing. 1 is a configuration diagram of an endoscope ligation device of a first embodiment and an endoscope to which it is applied; FIG. FIG. 4 is an explanatory view of a method of ligating a portion of living tissue including a lesion using the endoscopic ligation device of the first embodiment; Explanatory drawing following the previous drawing. Explanatory drawing following the previous drawing. Explanatory drawing following the previous drawing. Explanatory drawing following the previous drawing. FIG. 2 is a configuration diagram of a ligation device for an endoscope in a comparative form and an endoscope to which the same is applied; FIG. 11 is an explanatory view of a method of ligating living tissue in a portion including a lesion using an endoscopic ligation device of a comparative form; Explanatory drawing following the previous drawing. The block diagram of the ligature tool for endoscopes of 2nd Embodiment. The block diagram of the ligature tool for endoscopes of 3rd Embodiment.

[Endoscopic Ligating Tool and Endoscopic Ligating Device] (First Embodiment)
An endoscopic ligation tool and an endoscopic ligation device according to the first embodiment will be described below.
FIG. 1 is a configuration diagram of an endoscopic ligation device 1 according to a first embodiment. Note that the endoscope ligation device may be abbreviated as "ligation device". A ligature tool for an endoscope may be abbreviated as a "ligature tool".

As shown in FIG. 1 , the ligating device 1 includes a ligating tool 2 and an operating section 3 .
The ligature tool 2 includes a wire rod 21 , a fastener 22 and an extension body 23 . The wire rod 21 is flexible and formed in a ring shape (that is, endless). The wire 21 is made of synthetic resin, metal, or the like, for example. As the synthetic resin, for example, nylon, polyolefin, or the like can be used. Stainless steel, for example, is used as the metal. The wire 21 is preferably elastically bendable.

The fastener 22 has, for example, a tubular shape through which the wire rod 21 is inserted. The fastener 22 is provided at an intermediate position in the length direction (the X direction in FIG. 1) of the annular wire rod 21 . The fastener 22 forms a ligating loop portion 24 and a locking loop portion 25 by bundling the wire 21 at an intermediate position. A portion of the wire rod 21 on the distal end side of the fastener 22 is a ligature loop portion 24 . A portion of the wire rod 21 closer to the base end than the fastener 22 is a locking loop portion 25 . The ligature loop portion 24 and the locking loop portion 25 are each formed in a loop shape by folding back the wire rod 21 and bundling it around the fastener 22 . Reference numeral 24a denotes a tip portion of the wire rod 21 in the length direction (the X direction in FIG. 1).

The fastener 22 is positioned with respect to the wire 21 by frictional force while holding a portion of the wire 21 . The fastener 22 is displaceable in the lengthwise direction of the wire 21, and determines the size (e.g., diameter) of the ligating loop portion 24 and the locking loop portion 25 according to the lengthwise position of the wire 21. . For example, the size of the ligating loop portion 24 becomes smaller as the fastener 22 is closer to the tip portion 24a of the ligating loop portion 24, and larger as the fastener 22 is farther from the tip portion 24a.

The extending body 23 is formed so as to be able to extend outward from the ligating loop portion 24 of the wire rod 21 (in a direction away from the ligating loop portion 24). For example, when the ligating loop portion 24 is arranged along a plane, the extending body 23 can be arranged to extend outward from the ligating loop portion 24 along the plane. The extension body 23 is flexible and bendable.

As will be described later, when the ligating loop portion 24 is placed in the hood 6 and brought into contact with the living tissue 31, at least a portion of the extending body 23 is positioned between the distal end 6a of the hood 6 and the living tissue 31. It has a length that reaches between them (see FIG. 6). The length of extension 23 is preferably greater than the inner radius of hood 6 (half the inner diameter).

The extending body 23 is composed of, for example, a filamentous body 26 tied to the ligating loop portion 24 . The linear body 26 is, for example, a thread made of fibers such as synthetic fibers and natural fibers. Examples of natural fibers include silk thread, cotton thread, hemp thread, and the like. Examples of synthetic fibers include fibers composed of materials such as polyester, polyamide (for example, nylon), and polypropylene.

The extension body 23 has a first connection portion 27 and two extension portions 28 , 28 extending from the first connection portion 27 . The first tying portion 27 is a knot formed by tying the linear body 26 to the ligating loop portion 24 . The first connecting portion 27 is formed at the distal end portion 24 a of the ligating loop portion 24 . The two extensions 28, 28 are tied together at a position near the tip. A portion where the two extending portions 28 , 28 are connected is called a second connecting portion 29 . The second connecting portion 29 prevents the two extending portions 28, 28 from separating. The second connecting portion 29 also has the function of preventing the extension body 23 sandwiched between the hood 6 and the living tissue 31 from coming off (see FIG. 6).

2 to 4 are explanatory diagrams of a method of providing the extension body 23 on the ligature loop portion 24. FIG. As shown in FIG. 2, the first connecting portion 27 is formed by connecting the central portion of the linear body 26 to the distal end portion 24a of the ligating loop portion 24. As shown in FIG. As shown in FIG. 3, the second connecting portion 29 is formed by connecting the two extending portions 28, 28 together. As shown in FIG. 4, excess length portions 30 on the distal end side of the extending portions 28, 28 are cut off. As a result, the extending body 23 is provided on the ligating loop portion 24 .

As shown in FIG. 1, the operating section 3 operates the ligature tool 2 to ligate a part of the living tissue. The operating section 3 includes an insertion section 11 and a handheld operating tool 12 . The insertion section 11 includes a sheath 13 , an operation wire 14 and a hook 15 . The sheath 13 is a tubular body. Since the inner diameter of the sheath 13 is smaller than the outer diameter of the fastener 22 , the distal end of the sheath 13 can push the fastener 22 to move relative to the wire 21 . Therefore, the insertion portion 11 can change the relative position of the fastener 22 with respect to the wire rod 21 .

The operating wire 14 and hook 15 are provided within the sheath 13 . The hook 15 is connected to the tip of the operating wire 14 . The hand operation tool 12 is provided on the proximal end side of the operation wire 14 and can move the operation wire 14 forward and backward with respect to the sheath 13 .

FIG. 5 is a configuration diagram of the ligation device 1 and an endoscope 4 to which it is applied.
As shown in FIG. 5, the ligation device 1 is attached to an endoscope 4 and used. The endoscope 4 includes an endoscope main body 5 and a hood 6 (tip cylinder). The endoscope main body 5 incorporates an imaging device, a lens unit, and the like. As the imaging device, for example, a CCD (Charge Coupled Device), a CMOS (Complementary Metal Oxide Semiconductor), or the like can be used. In the endoscope 4, the distal direction of the endoscope main body 5 (downward in FIG. 5) is called "forward", and the direction opposite to the distal direction is called "backward".

The endoscope main body 5 has an insertion hole 7 . The insertion hole 7 is formed along the length direction of the endoscope main body 5 . The insertion hole 7 has a tip opening 7a on the tip surface 5a of the endoscope main body 5 . The insertion portion 11 of the ligation device 1 is inserted into the insertion hole 7 . Therefore, the insertion portion 11 is inserted into the endoscope main body 5 . The endoscope main body 5 has a suction hole (not shown) that opens to the distal end surface 5 a of the endoscope main body 5 . The endoscope main body 5 can suck the air in the internal space of the hood 6 through the suction hole to decompress the internal space.

A hood 6 is provided at the distal end of the endoscope main body 5 so as to extend forward. The hood 6 is, for example, cylindrical. The inner diameter of the hood 6 may be equal to or greater than the outer diameter of the endoscope body 5 . The central axis of the hood 6 is desirably aligned with the central axis of the endoscope main body 5 . Hood 6 is transparent. The visible light transmittance of the hood 6 is, for example, 50% or more in the entire wavelength region. The inner diameter of the hood 6 can be, for example, 10-16 mm.

Next, an example of how to use the ligation device 1 will be described with reference to FIGS. 1 and 5 to 10. FIG. 6 to 10 are explanatory diagrams of a method of ligating a portion of the body tissue 31 including the lesion 32 using the ligation device 1. FIG. The living tissue 31 is an object to be ligated, such as the wall of the large intestine. A diverticulum 33 is formed in the biological tissue 31 . The lesion 32 is, for example, a bleeding site occurring in a part of the diverticulum 33 .

As shown in FIG. 1 , the locking loop portion 25 of the ligature 2 is locked to the hook 15 , and the hook 15 is pulled into the sheath 13 using the hand manipulator 12 . Thereby, the locking loop portion 25 is pulled into the sheath 13 . A fastener 22 and a ligating loop 24 exit the distal end of the sheath 13 .

As shown in FIGS. 5 and 6, the ligature loop portion 24 protrudes into the hood 6 from the distal end of the insertion portion 11. As shown in FIGS. As shown in FIG. 6, under observation with the endoscope 4, the tip 6a of the hood 6 is brought into contact with the mucous membrane surface 31a of the living tissue 31 over the entire circumference. At this time, the hood 6 is arranged at a position surrounding the diverticulum 33 when viewed from the endoscope main body 5 . Since the hood 6 is transparent, a wide area of the living tissue 31 can be observed with the endoscope main body 5 . Therefore, it becomes easy to find the diverticulum 33 with a lesion and to arrange the hood 6 at a position surrounding the diverticulum 33 .

The length of the ligature loop portion 24 in the hood 6 is adjusted by pushing or pulling the wire rod 21 through the operating wire 14 (see FIG. 1) by operating the hand manipulator 12 (see FIG. 1). In FIG. 6 , a portion of the ligation loop portion 24 is in contact with the living tissue 31 . A portion of the ligating loop portion 24 (for example, a portion including the distal end portion 24 a of the ligating loop portion 24 ) is in contact with the inner peripheral surface of the hood 6 . The ligation loop portion 24 is arranged at a position surrounding the diverticulum 33 when viewed from the endoscope main body 5 .

The extending body 23 extends outside the hood 6 because it extends outward from the ligating loop portion 24 . Therefore, part of the extension body 23 is sandwiched between the tip 6 a of the hood 6 and the living tissue 31 . Therefore, when the length of the ligating loop portion 24 in the hood 6 is adjusted by operating the hand manipulating tool 12 (see FIG. 1), the distal end portion 24a of the ligating loop portion 24 hits the inner peripheral surface of the hood 6, causing the living body to sag. Lifting from the tissue 31 can be suppressed.

As shown in FIG. 7, the internal space of the hood 6 is depressurized using a suction hole (not shown). As a result, the diverticulum 33 is aspirated and inverted, and forms a bulging shape inwardly of the living tissue 31 (large intestine wall) in the hood 6 . The reversed diverticulum 33 (hereinafter referred to as reversed diverticulum 33A) is surrounded by the ligating loop portion 24. As shown in FIG. As described above, the ligating loop portion 24 is in a state where lifting is suppressed, so that it surrounds the base of the everted diverticulum 33A.

As shown in FIGS. 8 and 9, the operation wire 14 (see FIG. 1) is pulled and the sheath 13 is extended from the endoscope main body 5 by operating the hand manipulating tool 12 (see FIG. 1). As a result, the ligation loop portion 24 is pulled into the sheath 13, but the fastener 22 abuts against the distal end of the sheath 13 and its displacement is restricted. Therefore, the fastener 22 is displaced relative to the ligature loop portion 24 in a direction toward the distal end portion 24a. As a result, the ligating loop portion 24 is reduced in diameter and tightens the base of the reversed diverticulum 33A. In FIG. 9, the bases of the everted diverticula 33A are clustered and in contact with each other. As a result, the inverted diverticulum 33A including the lesion 32 is ligated.

As shown in FIG. 10, a cutting tool (not shown) inserted into the hood 6 through an insertion hole (not shown) of the endoscope main body 5 cuts a portion of the wire 21 (specifically, a portion on the proximal side of the fastener 22). ). This completes the ligation procedure for the reversed diverticulum 33A.

For example, several days after the ligation procedure, the ligated reversed diverticulum 33A becomes necrotic due to cessation of blood flow and falls off. Therefore, the lesion 32 (eg, bleeding site) is removed from the living tissue 31 . If the lesion 32 is a bleeding site, bleeding can be reliably stopped.

As shown in FIG. 6, the ligating tool 2 of the first embodiment includes the extending body 23 extending from the ligating loop portion 24. Therefore, when ligating the reversed diverticulum 33A, the extending body 23 is A part of it is sandwiched between the tip 6 a of the hood 6 and the living tissue 31 . Therefore, when adjusting the length of the ligation loop portion 24 in the hood 6 , it is possible to prevent the tip portion 24 a of the ligation loop portion 24 from rising from the biological tissue 31 . Therefore, as shown in FIG. 7, when ligating the reversed diverticulum 33A (the portion of the living tissue 31 including the lesion 32), the ligation loop portion 24 is less likely to be displaced, and as shown in FIGS. , the entire inverted diverticulum 33A can be reliably ligated. The ligature tool 2 can remove the lesion 32 even when the lesion 32 is located near the base of the inverted diverticulum 33A.

In order to clarify the effects of the ligation device 1 of the first embodiment, a ligation device 101 of a comparative form will be described with reference to FIGS. 11 to 13. FIG. FIG. 11 is a configuration diagram of a ligation device 101 and an endoscope 4 to which it is applied. 12 and 13 are explanatory diagrams of a method of ligating a portion of the body tissue 31 including the lesion 32A using the ligating device 101 of the comparative form. As shown in FIG. 11, the ligation device 101 has the same configuration as the ligation device 1 of the first embodiment except that the extending body 23 (see FIG. 5) is not provided.

As shown in FIG. 11, in the ligating device 101, when adjusting the length of the ligating loop portion 24 in the hood 6 by operating the hand manipulator 12 (see FIG. 1), the distal end portion 24a of the ligating loop portion 24 is adjusted. may hit the inner peripheral surface of the hood 6 and rise from the living tissue 31 . Therefore, as shown in FIGS. 12 and 13, the tightening position of the ligating loop portion 24 may be off the base of the reversed diverticulum 33A. Therefore, if the lesion 32A is located near the base of the inverted diverticulum 33A, it may not be possible to remove the lesion 32A.

[Endoscope Ligature] (Second Embodiment)
Next, a ligature tool for endoscopes according to a second embodiment will be described. FIG. 14 is a configuration diagram of a ligature tool 2A of the second embodiment. As shown in FIG. 14, the ligature tool 2A differs from the ligature tool 2 of the first embodiment (see FIG. 1) in that the extending body 23A is integrally formed with the ligature loop portion 24A. The extending body 23A extends outward from the ligating loop portion 24A. The ligature tool 2A can be manufactured by integral molding.

Since the posture of the extension body 23A relative to the ligation loop portion 24A of the ligature tool 2A is difficult to change, the extension body 23A tends to assume a posture in which the extension body 23A extends outward from the ligation loop portion 24A. Therefore, the extending body 23A is easily sandwiched between the distal end 6a of the hood 6 and the living tissue 31. As shown in FIG.

[Endoscope Ligature] (Third Embodiment)
Next, a ligature tool for endoscopes according to a third embodiment will be described. FIG. 15 is a configuration diagram of a ligature 2B of the third embodiment. As shown in FIG. 15, the ligature 2B differs from the ligature 2 of the first embodiment (see FIG. 4) in that it has two extension bodies 23B.
Since the ligature tool 2B has two extending bodies 23B, the extending bodies 23B are easily sandwiched between the distal end 6a of the hood 6 and the living tissue 31 (see FIG. 6).

As shown in FIG. 10, the ligature tool 2 is configured such that only the portion including the ligature loop portion 24 is left in the living tissue 31 by cutting the portion of the wire rod 21 closer to the proximal end than the fastener 22 . is preferable, the ligature 2 with the uncut wire 21 may be retained by removing the locking loop portion 25 from the hook 15 (see FIG. 1).
In the ligature tool of the embodiment, the number of extension bodies is not particularly limited, and may be one or any number of two or more.
In the ligature tool of the embodiment, the extension body may be formed so as to be able to extend outward (in a direction away from the ligature loop section) from the ligature loop section of the wire. In other words, even if the extension body is arranged so as not to extend outward from the ligation loop portion in a normal configuration, it has a structure that can extend outward from the ligation loop portion during ligation. I wish I had.

DESCRIPTION OF SYMBOLS 1... Endoscope ligation apparatus, 2, 2A, 2B... Endoscope ligation tool, 3... Operation part, 4... Endoscope, 5... Endoscope main body, 6... Hood (tip cylinder), 6a Front end of hood 11 Insertion part 12 Manual operation tool 21 Wire rod 22 Fastener 23, 23A, 23B Extension body 24, 24A, 24B Ligation loop part 31 Biological tissue (ligation object).

Claims (4)

An endoscopic ligating device for use in an endoscope having an imaging unit and a distal end barrel that abuts on an object to be ligated,
A ligature tool for an endoscope, comprising: a flexible wire; a fastener that forms a ligation loop by folding and bundling the wire into a loop; and an extension body that extends from the ligation loop. ,
and an operation unit for adjusting the size of the ligation loop,
The fastener can be displaced in the length direction of the wire, and can determine the size of the ligation loop according to the position in the length direction of the wire,
The operation section has an insertion section inserted into the endoscope,
The insertion portion adjusts the size of the ligation loop by changing the relative position of the fastener with respect to the wire,
The extension body is a lifting suppression member that is sandwiched between the distal end of the distal end cylinder and the ligation object to suppress the ligation loop from rising from the ligation object. ligation device. 2. The ligating device for an endoscope according to claim 1 , wherein said extension body is a linear body tied to said ligating loop. The ligating device for an endoscope according to claim 2 , wherein the filamentous body is a thread made of fiber. An endoscope comprising a ligating device for an endoscope according to any one of claims 1 to 3 , an imaging section, and a distal end barrel that abuts on an object to be ligated.

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