JPH03123545A - Treatment instrument for endoscope - Google Patents

Abstract

PURPOSE:To obtain a treatment instrument safe for patients and moreover, high in incising performance by a method wherein this device is provided at an excision device, a laser light emission end is arranged at an excising section and a laser guide is included which allows a laser light from a laser generator to irradiate the excising section. CONSTITUTION:An excising device 1 is inserted into a body cavity and an excising section 2 is introduced to an intended part. With a knife section 4 kept open to a receiving section 3, a morbid tissue is arranged between the receiving section 3 and the knife section 4. Under such a condition, the knife section 4 is closed by an action at a hand portion and the morbid tissue is incised mechanically with blades 12 and 15 of the both. At this point, a laser generator 26 is operated to generate a laser light to be irradiated toward the first blade 12 of the receiving section 3 through a laser guide 25. As a result, the first blade 12 of the receiving section 3 is heated by heat energy of the laser light to cauterize the morbid tissue. This achieves a higher incising performance facilitating the incision and excision of even a hard part. This also allows the use of harmless laser light, thereby achieving a safe treatment.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention relates to an endoscopic treatment instrument used for incising and resecting a lesion occurring in a living body, a stenosis in a body cavity, and the like.

[Prior Art] Japanese Unexamined Patent Publication No. 194847/1984 discloses a high-frequency incision device for an endoscope that uses high-frequency current to incise, for example, a constricted portion in a body cavity. In this method, a pair of holes are bored at intervals on the side surface of the tip of an insulating tube, and a conductive wire is bulged out between these holes.By passing a high-frequency current through this wire, the above-mentioned The stenosis is removed by cauterizing and incising the body cavity wall in contact with the bulge.

Further, Japanese Utility Model Application No. 63-i30097 discloses, for example, scissor forceps for mechanically cutting off a lesion in a living body. This has a cutting part at the tip consisting of a scissor part with a blade on the inside and a receiving part with a blade that intersects with this blade, and the scissor part can be opened and closed from the receiving part by operation on the hand side. By placing the diseased tissue between the receiving part and the scissors, and then closing the scissors, the diseased tissue is mechanically cut by both blades.

[Problems to be Solved by the Invention] However, in the case of the above-mentioned high-frequency incision device for an endoscope, since high-frequency current is used for treatment, it is difficult to use this for, for example, removing blood clots in cardiovascular vessels or incising valves. , there is a risk that high-frequency current may pass through the patient's heart and cause an electric shock.
Extremely dangerous.

Therefore, an endoscopic high-frequency insector cannot be used in such areas, and the areas to which it can be applied are limited.

In addition, in the case of the scissor forceps mentioned above, the scissors are opened and closed by the operation on the hand side to mechanically cut the diseased tissue. In such cases, it is difficult to mechanically cut these parts using only the opening/closing force of the scissors by hand-side operation, and the applicable parts are still limited.

The present invention has been made in view of the above circumstances, and its purpose is to provide an endoscopic treatment tool that is safe for patients and has a high incision ability.

[Means and Functions for Solving the Problems] To achieve the above objects, the present invention provides a resection tool having a resection section at its tip for resecting a lesion in a living body, and a laser beam emitting end provided on the resection tool. and a laser guide which is disposed in the cut portion and is capable of irradiating the cut portion with laser light from a laser generator.

Then, when incising and resecting a lesion in the body or a stenosis in a body cavity using the resection section, the laser guide is used to incise the resection section.
A living body is irradiated with laser light that does not cause an electric shock and is heated. Then, the lesion is mechanically excised by this resection portion, and the lesion is cauterized and resected by the heat.

[Example] Hereinafter, FIGS. 1 to 5 will be explained regarding the first example of the present invention.
This will be explained with reference to the figures.

FIG. 5 shows the entire endoscopic treatment tool of the present invention, and 1 is a cutting tool. A cutting section 2 is provided at the tip of the cutting tool 1, and the cutting section 2 is composed of a receiving section 3 and a knife section 4 provided to the receiving section 3 so as to be openable and closable. That is, as shown in FIGS. 1 to 3, the receiving part 3 consists of a base end part 5, a main body part 6, and a distal end part 7, and a mounting hole 8 passes through the base end part 5 in the axial direction. It is perforated. Further, a housing hole 9 is bored in the main body 6 and communicates with the mounting hole 8, passing through the main body 6 in the radial direction (vertical direction). Furthermore, one side of the tip 7 is cut out, and a recess 10 that communicates with the accommodation hole 9 is formed in the other side so as to penetrate in the axial direction. This recess 10 is in the radial direction (vertical direction)
The central part communicates with the notch 11, and a sharp first blade 12 is provided along the axial direction at the inner upper edge of the recess 10 at the tip 7 (the communication part between the recess 0 and the notch 11). It is formed.

The knife portion 4 includes a knife body 13 and a pair of tongue portions 14 protruding from both sides of the rear end surface of the knife body 13.
14, and a sharp second blade 15 is formed along the axial direction at the lower edge of the knife body 13. The knife portion 4 is accommodated in the accommodation hole 9 and the recess 10 of the receiving portion 3, and the rear end portion of the knife body 13 extends through the first main body portion 6 of the receiving portion 3 in the radial direction (horizontal direction). supporting shaft 1
It is rotatably supported by 6. Furthermore, a second support shaft 17 is provided between the tongue portions 14 and 14 in a state in which the knife portion 4 is closed relative to the receiving portion 3 (in the state shown in FIG. One end of an operating wire 18 is connected to the second support shaft 17 by winding it around the second support shaft 17 .

Further, one end of an inner tube 19 is inserted and fixed into the attachment hole 8 of the proximal end portion 5 of the receiving portion 3.
At the other end, as shown in FIG. 5, an operating section 20 is provided. This operating section 20 consists of a gripping section 21 that is integrally fixed to the inner tube 19, and a slider 22 that is slidably inserted into this gripping section 21. The ends are fixed integrally through the inner tube 19. Therefore, by gripping the gripping portion 21 and sliding the slider 22, the operating wire 18 slides within the inner tube 19, thereby rotating the knife portion 4 about the first support shaft 16. However, the operating wire 18 is normally biased forward (in the direction A in FIG. 4), so that the knife portion 4 is held open relative to the receiving portion 3.

Then, by pulling the operating wire 18 backward (direction B in FIG. 2) against the biasing force in the direction A, the knife part 4 is closed relative to the receiving part 3, and the blades 12 and 15 of both blades 12 and 15 are closed. are arranged so that they intersect in contact with each other. In addition,
A positioning tool 23 is provided at the inner end of the inner tube 19 for positioning the operating wire 18 at the center of the tube in the radial direction.

As shown in FIG. 1, an insertion hole 24 is formed in one side of the receiving part 3 along the axial direction from the rear end surface of the base end part 5 to the main body part 6. One end of a laser guide 25 is inserted and fixed into this insertion hole 24, and the other end of this laser guide 25 has a laser generator 2 as shown in FIG.
6 is connected. Here, the emission end 27 formed at one end of the laser guide 25 is cut so as to be able to emit laser light toward the first blade 12 of the receiver 3 located in front of the side thereof. Therefore, the laser light generated by the laser generating bag W26 is guided by the laser guide 25,
The light is irradiated from the output end 27 toward the first blade 12 side. Note that an outer skin tube 28 is coated on the outside of the inner tube 19 and the laser guide 25, and the tube 19 and the laser guide 25 are combined into one tube in a parallel state.

In such a configuration, the resection tool 1 is inserted into the body cavity through a forceps channel or the like of an endoscope (not shown), and the resection portion 2 is guided to the target site. Then, the diseased tissue is placed between the receiving part 3 and the knife part 4 while keeping the knife part 4 open to the receiving part 3. In this state, the knife portion 4 is closed by an operation on the hand side, and the diseased tissue is mechanically cut by both blades 12 and 15. At this time, the laser generator 26 is operated to generate a laser beam, which is irradiated onto the first blade 12 side of the receiver 3 via the laser guide 25. Then, the first blade 12 of the receiving part 3 is heated by the thermal energy of the laser beam, thereby causing both blades 12.
When the diseased tissue is mechanically cut at 15, the diseased tissue is cauterized by the heat of the first blade 12.

In this manner, when incising and resecting a diseased part in a living body or a constricted part in a body cavity, in addition to mechanically cutting the diseased tissue with the blades 12 and 15 of the receiving part 3 and the knife part 4, the blades 12 and 15 of the receiving part 3 Since the blade 12 of No. 1 is heated by a laser beam and cauterizes the diseased tissue with the heat, its incision ability can be improved and even hard parts can be easily incised and resected. Moreover, since a harmless laser beam is used as a heating means for the first blade 12 instead of a high frequency current or high voltage electricity that may cause an electric shock to the living body, the treatment can be performed safely.

6 to 8 show a second embodiment of the invention.

In this embodiment, the resection tool 1 includes a sheath 31, a resection section 2 provided at the distal end of the sheath 31, and an operating section 20 provided at the rear end of the sheath 31.

Each of the cutting parts 2 has a sharp blade 32.
It consists of a pair of scissors 34.35 having a diameter of 33, which are normally kept spaced apart from each other. A joint tool 36 is attached to the rear end of each scissor portion 34.35 to connect the scissor portion 34.35 to the blade 32.
33 is fixed so that it faces inward. A protective tube 37 is connected to this joint tool 36. Also,
One end of the operating wire 18 is connected to the rear end of each scissors 34 , 35 , and the other end of the operating wire 18 is integrally connected to the slider 22 of the operating section 20 through the sheath 31 .

Therefore, by grasping the grip part 21 of the operating part 20 and sliding the slider 22, the operating wire 18 slides within the sheath 31, thereby moving the resection part 2 forward and backward. That is, when the operating wire 18 is pushed in by the operation on the proximal side, the cutout part 2 is projected from the distal end of the sheath 31, as shown in FIG. 7, and the scissor parts 34 and 35 are separated from each other. Conversely, when the operating wire 18 is pulled in, as shown in FIG. 8, the outer surface of each scissor portion 34, 35 abuts against the hard tip portion 38 of the sheath 31, and both blades 32, 33 intersect with each other in contact with each other. It is supposed to be done. moreover,
A laser guide 25 is inserted into the sheath 31 from the rear end side, and the tip of this laser guide 25 is connected to the protective tube 3.
7 and is inserted and fixed into each scissor part 34,35. Here, the emission end portion 27 of the laser guide 25 is cut diagonally so that the laser beam can be emitted toward the blades 32, 33 of each scissors 34, 35. Therefore, the laser beam generated by the laser generator 26 is guided by the laser guide 25, and is irradiated from the output end 27 onto the blades 32, 33 of each scissors 34, 35.

The other basic configurations and operations are the same as those of the first embodiment, and in addition to the effects of the first embodiment, the structure is relatively simple and can be easily miniaturized.

FIG. 9 shows a third embodiment of the invention.

In this embodiment, a basket part 41 is used as the cutting part 2. One end of the operating wire 18 is connected to the rear end of the basket section 41, and the other end of the operating wire 18 is integrally connected to the slider 22 of the operating section 20 through the inside of the sheath 31. Therefore, by grasping the grip part 21 of the operating part 20 and sliding the slider 22, the operating wire 18 slides within the sheath 31, thereby moving the resection part 2 forward and backward. In other words, the operation at hand
When the operating wire 18 is pushed in, the resection portion 2 is projected from the distal end of the sheath 31, and the basket portion 41 is expanded. Conversely, when the operating wire 18 is pulled in, the basket portion 4
The outer surface of the sheath 31 abuts against the distal end of the sheath 31, causing the basket portion 41 to contract. Also, sheath 3
1, a laser guide 25 is inserted from the rear end side,
The distal end of the laser guide 25 is inserted and fixed through the protective tube 37 into a heating section 42 provided at the distal end within the sheath 31 . A plurality of rollers 43 are provided above and below inside the heating section 42, and the operating wire 18 is inserted through the gap between the upper and lower rollers 43. Therefore, the laser light generated by the laser generator 26 is guided by the laser guide 25 and is irradiated onto the heating section 42 from its output end 27 . The heat from the heating section 42 is transmitted to the basket section 41 via the roller 43 and the operating wire 18.

The other basic configurations and functions are the same as those of the second embodiment, and in addition to the effects of the first embodiment, the excised diseased tissue can be recovered into the basket portion 41.

[Effects of the Invention] As described above, according to the present invention, when incising and resecting a lesion in a living body or a stenosis in a body cavity, in addition to mechanically cutting the lesion by the resection part, the resection part is Since the lesion is heated by a laser beam and the lesion is cauterized with the heat, the incision ability can be improved, and even hard areas can be easily incised and resected. Furthermore, since a laser beam that does not cause an electric shock to the living body is used as a heating means for the resection portion, the treatment can be performed safely.

[Brief explanation of drawings]

1 to 5 show a first embodiment of the present invention, in which FIG. 1 is a plan view of the cut portion, FIG. 2 is a side view, also partially cut away, and FIG. 3 is a front view. FIG. 4 is a partial sectional view showing the operation, FIG. 5 is an overall configuration diagram, and FIGS. 6 to 8 show a second embodiment of the present invention. 7 and 8 are perspective views showing the operation of the cutting section, respectively, and FIG. 9 is an overall configuration diagram showing a third embodiment of the present invention. DESCRIPTION OF SYMBOLS 1... Cutting tool, 2... Cutting part, 25... Laser guide, 26... Laser generator, 27... Output end part.

Claims (1)

[Claims] A resection tool having a resection section at its tip for resecting a lesion in a living body, and a laser beam emitting end provided on the resection tool arranged in the resection section, so that the resection section can be irradiated with laser light from a laser generator. An endoscopic treatment instrument characterized by comprising a laser guide.