JPH03162845A - Organism inspection tool - Google Patents

Abstract

PURPOSE:To easily and surely collect a large amount of tissue by providing a treatment tool insertion path provided in a flexible tube and to which either a holding tool or a cutting tool is inserted, an intake means to suck the air in space at the tip side of the flexible tube, and a blocking means to block a gap between an endoscope and the flexible tube. CONSTITUTION:The flexible tube 2 of the organism inspection tool 1 is inserted to the gullet 24, and following that, the insertion part 5 of the endoscope 4 is inserted to the endoscope insertion channel 6 of the flexible tube 2 at a state where the balloon 19 of the part is contracted, and the flexible tube 2 is advanced under the observation of the endoscope 4, then, it is guided to a targeted part. Furthermore, a holding forceps 15 is inserted to the forceps channel 14 of the endoscope 4 at a state where the holding part 18 of the forceps is closed, and also, a high-frequency snare 9 is inserted to the treatment tool insertion channel 8 of the flexible tube 2 at a state where a wire pool 12 is pulled in. Then, the holding forceps 15 is inserted to the wire loop 12 of the high-frequency snare 9 by protruding the tip parts of the holding forceps 15 and the high-frequency snare 9 in the neighborhood of the aperture part at the tip of the flexible tube 2. At such a state, the balloon 19 is expanded by pushing the piston 23 of a cylinder 22 in a direction of S, which blocks the gap between the endoscope 4 and the flexible tube 2.

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to a biopsy tool used when collecting tissue within a body cavity.

[Prior art] Generally, when collecting tissue inside a body cavity under observation with an endoscope,
A biopsy method in which biopsy forceps or a suction biopsy needle is inserted into a channel of an endoscope to pinch tissue or suction the surface mucous membrane, or a biopsy method that has two channels (not shown) as shown in Fig. 19. A biopsy method (strip biopsy) has been carried out in which the root portion of tissue C is picked up with grasping forceps b and cut with a high-frequency snare d using an endoscope a.

[Problems to be Solved by the Invention] However, the above-mentioned biopsy methods using biopsy forceps or aspiration biopsy needles can only collect a small amount of tissue at a time, which is not useful for the purpose of treatment, and diagnosis cannot be carried out on a monthly basis. Even in this case, a definitive diagnosis could not be made because the amount of tissue sampled was small.

In addition, in the case of the strip biopsy shown in Fig. 19, the tissue C is
The problem was that it required a high degree of technical skill as it required cutting and collecting. Furthermore, as shown in FIG. 20, for example, if the grasping forceps b cannot be applied to the tissue C at an angle close to a right angle in the esophagus, the grasping forceps b may slip and cannot reliably grasp the tissue C. Moreover, since the grasping forceps b and the high-frequency snare d protrude from almost the same position at the tip of the endoscope a, the high-frequency snare d can be
At the base of tissue C picked up with <<, tissue C
It was difficult to reliably collect.

The present invention has been made in view of the above circumstances, and its purpose is to provide a biopsy tool that can easily and reliably collect a large amount of tissue.

[Means for Solving the Problems] In order to achieve the above object, the biopsy tool of the present invention includes a treatment tool insertion passage provided in a flexible tube and through which at least one of a grasping tool and a cutting tool is inserted; The flexible tube includes a suction means for sucking air from the space on the distal end side of the flexible tube, and a closing means for closing a gap between the endoscope and the flexible tube.

[Operation] In such a configuration, when the endoscope is inflated inside the flexible tube and inserted into the body cavity and guided to the target site, the gripping tool is inserted through the endoscope or treatment instrument insertion passage. At the same time, the cutting instrument is inserted into the body cavity through the treatment instrument insertion passage or through the endoscope. In this state,
The closing means closes the gap between the endoscope and the flexible tube, and the suction means sucks the air in the space at the distal end of the closing means, thereby applying negative pressure inside the body cavity and moving the tissue inside the body cavity into the flexible tube. Attract it to the opening. Then, the tissue is pinched with the gripping tool to make it easy to cut, and then the tissue is cut with the cutting tool and collected.

[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. 1 shows the structure of a biopsy tool 1 of the present invention. This consists of a long flexible tube 2 and a large diameter ring-shaped grip 3 attached to the proximal end of the flexible tube 2.

An endoscope insertion channel 6 is formed within the flexible tube 2, into which a flexible insertion section 5 of an endoscope 4, which will be described later, can be inserted.

Furthermore, as shown in FIG. 2, the inner wall of the flexible tube 2 has one end opened near the distal opening of the flexible tube 2, and the other end opened to one side of the proximal end of the flexible tube 2. A treatment tool ventilation channel 8 is provided along the longitudinal direction of the flexible tube 2. A treatment tool, here a high frequency snare (cutting tool) 9, is pushed through this channel 8.

The high-frequency snare 9 is provided with an operating handle 11 on the proximal side, and a wire lube 12 on the distal end side. Furthermore, this high-frequency snare 9 has a smaller diameter than the treatment instrument insertion channel 8, and its operating handle 11
When the wire lube 12 is slid in the direction 81 in FIG. 1, the wire lube 12 protrudes and retracts (expands and contracts) from the tip. Note that a high frequency generator and an extracorporeal electrode plate (both not shown) are connected to the base end side of the wire lube 12.

The endoscope 4 also includes an endoscope insertion channel 6 of the flexible tube 2.
An insertion section 5 having a smaller diameter than the insertion section 5 and an operation section 13 connected to the proximal end of the insertion section 5 are provided. An observation optical system and an illumination optical system (neither of which are shown) are provided inside the endoscope 4, and a forceps channel 14 passes through the insertion section 5 and is located on one side of the operation section 13. It is provided with an opening in the section. The proximal end side of the forceps channel 14 branches within the operating section 13, and a suction device (not shown) is connected to the branched end. Therefore, the forceps channel 14 is also used as an intake channel (intake means).

In addition, a grasping forceps (gripping tool) 1 is provided in the forceps channel 14.
5 is inserted. The gripping forceps 15 is provided with an operating handle 17 on the proximal side and a gripping part 18 on the distal end side.

The gripping forceps 15 have a smaller diameter than the forceps channel 14, and when the operating handle 17 is slid in the direction 32 in FIG.

Furthermore, internal vision 1l! A balloon (opening/closing means) that closes the gap between the endoscope 4 and the flexible tube 2 is provided on the outer periphery of the distal end side of the insertion section 5 of 4.
19 is attached. An air supply syringe 22 is connected to each balloon via an air supply tube 20 and a switching cock 21. When the piston 23 of this syringe 22 is pushed in the direction 83 in FIG.
9 expands and comes into close contact with the inner peripheral surface of the flexible tube 2. Furthermore, when the piston 23 is pulled out in the opposite direction, the air inside one balloon is sucked into the syringe 22, causing one balloon to deflate.

Next, a description will be given of an operating procedure for collecting tissue within a body cavity, here the esophagus 24, using the biopsy tool 1 having such a configuration. First, as shown in FIG. 2, the flexible tube 2 of the biopsy tool 1 is orally inserted into the esophagus 24, and then the insertion section 5 of the endoscope 4 is inserted with the balloon 19 deflated. Insert into the endoscope insertion channel 6 of the flexible tube 2. Next, the flexible tube 2 is pushed forward under observation with the endoscope 4 and guided to the target site. Furthermore, the third
As shown in the figure, the grasping forceps 15 is inserted into the forceps channel 14 of the endoscope 4 with its grasping part 18 closed, and the high-frequency snare 9 is inserted into the flexible tube 2 with its wire loop 12 pulled in. Insert into the treatment instrument insertion channel 8. Then, the distal ends of the grasping forceps 15 and the high-frequency snare 9 are protruded near the tip opening of the flexible tube 2, and the grasping forceps 15 is passed through the wire loop 12 of the high-frequency snare 9.

In this state, the piston 23 of the syringe 22 is pushed in the direction 83 to inflate the balloon 19 as shown in FIG. Furthermore, in this state, the switching cock 21 is closed to maintain the inflated state of the balloon 19.

Then, this balloon 19 connects the endoscope 4 and the flexible tube 2.
The gap between the balloon 19 and the balloon 19 is closed, thereby airtightly partitioning the front end space and the rear end space with the balloon 19 in between.

In this state, next, forceps channel 1 of endoscope vL4
4, the air in the space on the distal end side is suctioned. In this case, since the gap between the endoscope 4 and the flexible tube 2 is closed by one balloon, the inside of the esophagus 24 becomes negative pressure, and the esophageal wall 2
4a is attracted to the opening at the tip of the flexible tube 2 and comes into close contact with the opening at the tip so as to close the opening. Note that the gap between the high-frequency snare 9 and the flexible tube 2 is very small, and is at a level that causes no problem when suctioning the esophageal wall 24a. After that, the flexible tube 2
Move it forward and backward, rotate it, and internally look at the area you want to biopsy!
4 at a position where it can be easily grasped with the grasping forceps 15, and as shown in FIG. Then, a part of the esophageal wall 24a is pulled up into the wire loop 12 of the high-frequency snare 9, and the wire loop 12 is hung around the base of the wire loop 12. In this state, the wire loop 12 is pulled in by sliding the operating handle 11 of the high-frequency snare 9, and a high-frequency current is passed through the loop 12 while tightening the esophageal wall 24a, thereby cauterizing and cutting the esophageal wall 24a. At this time, an extracorporeal electrode plate is set in advance near the subject's inspection site. After that, the switching cock 21 is switched to the open state to release the balloon 1.
At the same time as removing the air from the esophagus, the suction from the forceps channel 14 is stopped to return the inside of the esophagus 24 to normal pressure, and then the endoscope 4 is pulled out from the flexible tube 2 to collect the tissue piece. It is something.

In this way, when collecting the tissue within the esophagus 24, since the esophageal wall 24a is adsorbed to the distal opening of the flexible tube 2, the grasping forceps 15 is held at a nearly right angle to the esophageal wall 24a. 24a, the grasping forceps 15 can be prevented from slipping, and the gripping forceps 15 can easily grasp the esophagus wall 24a. Furthermore, since the grasping forceps 15 is inserted into the forceps channel 14 of the endoscope 4 and the high-frequency snare 9 is inserted into the treatment instrument insertion channel 8 of the flexible tube 2, the grasping forceps 15 and the high-frequency snare 9 are inserted into the forceps channel 14 of the endoscope 4. The high frequency snare 9 is projected from a relatively distant position.
This makes it easier to hang the wire lube 12 on the base of the esophagus wall 24a picked up with the gripping forceps 15. From the above, even in a region where it is difficult to grasp tissue, such as the esophagus 24, tissue can be reliably and easily cut and harvested by the combination of the grasping forceps 15 and the high-frequency snare 9.

In addition, since the high-frequency snare 9 for cutting the esophageal wall 24a protrudes from a portion close to the peripheral wall of the flexible tube 2, the wire lube 12 can be easily and reliably hung on the root portion of the esophagus u24a. Large tissue biopsies can be easily performed. Furthermore, since the flexible tube 2 inserted into the esophagus 24 suppresses the movement of the esophageal wall 24a, a series of operations can be performed easily.

Figures 6 through 9 show a second embodiment of the invention.

In this embodiment, one balloon is attached not to the endoscope 4 side but to the inner periphery of the distal end side of the endoscope insertion channel 6 of the flexible tube 2, and the treatment instrument insertion channel 8 is attached to the distal end of the flexible tube 2. A tissue intake groove 31 that is open at the tip of the flexible tube 2 is provided opposite to the flexible tube 2, and the other basic configuration is the same as that of the first embodiment.

In this case, after pinching the esophageal wall 24a with the grasping forceps 15, the air inside the balloon 19 is removed to return the inside of the esophagus 24 to normal pressure, and the flexible tube 2 is moved back and forth, or rotated to pinch the esophageal wall 24a. After placing the esophageal wall 24a in front of the tissue intake groove 31, push the flexible tube 2 forward to take the esophageal wall 24a into the tissue intake groove 31, and then insert the wire loop 12 of the high frequency snare 9 into the root of the esophageal wall 24g. It is hung and cut.

In this way, the distal end of the flexible tube 2 can be filled with tissue 31.
In addition to the effects mentioned in the first embodiment, the wire loop 12 of the high-frequency snare 9 and the sheath 9a become straight, and the wire loop 12 is connected to the esophageal wall 24a. It becomes easier to hang it on the base of the. In addition, as shown in FIG. 9, the esophageal wall 2 is
4a, the esophagus wall 24a has entered the tissue intake groove 31, so the muscular layer 3 below the mucosal layer 32
3 is regulated by the tissue intake groove 31 and does not hang up, and only the mucosal layer 32 can be cut and collected. Here, if the esophageal wall 24a is simply picked up with the grasping forceps 15 and the root portion of the esophageal wall 24a is cut using a high-frequency snare as shown in FIG. If you cut down to muscle layer 33 like this,
It is extremely dangerous as it may cause bleeding or perforation.

FIG. 11 shows a third embodiment of the invention.

In this embodiment, two of the first treatment instrument insertion channel 35 and the second treatment instrument insertion channel 36 are provided on the inner wall of the flexible tube 2 at positions shifted by 180'', and the grasping forceps 15 are inserted into the endoscope 4.
A type of high frequency device that is inserted into the first treatment instrument insertion channel 35 instead of the forceps channel 14 of The second needle knife 38
is inserted into the treatment instrument insertion channel 36 of the flexible tube 2, and in place of the balloon, an occlusion valve 39 having a passage hole smaller in diameter than the insertion portion 5 of the endoscope 4 is inserted on the distal end side of the endoscope insertion channel 6 of the flexible tube 2. It is attached to the inner peripheral part, and the other basic configuration is the same as that of the first embodiment. In this case, the forceps channel 14 of the endoscope 4 is used to supply air to the space on the distal end of the occlusion valve 39 to return the inside of the esophagus 24 to normal pressure.

In this way, since the high-frequency needle-like scalpel 38 is used, in addition to the effects mentioned in the first embodiment, the cutting range is not limited to a small area unlike the high-frequency snare, and larger pieces of tissue can be cut. Since the forceps channel 14 of the endoscope vL4 can be used as a dedicated suction and exhaust path, the suction and exhaust force is strong, and the esophagus 24 can be reliably and quickly brought to negative pressure, or this negative pressure can be reliably and quickly created. It can be solved as

Further, FIGS. 12 to 16 show a fourth embodiment of the present invention.

In this embodiment, a substantially rectangular side hole 40 is provided in the peripheral wall of the distal end of the flexible tube 2, as shown in FIGS. 12 and 13. Furthermore, this flexible tube 2 has a built-in high frequency power transmitter 41. The high-frequency power cutter 41 is provided with an operating wire 42 that is slidably mounted in the axial direction within the treatment instrument insertion channel 8 and a knife portion 43 that is connected to the tip of the operating wire 42.

As shown in FIG. 14, this knife portion 43 has a pair of support arms 44a, 44b&f disposed substantially parallel to each other and spaced apart from each other.
A substantially U-shaped holder 44 is provided. A connecting boss portion 45 with the operating wire 42 is provided approximately at the center of the connecting arm 44c that connects the base ends of both support arms 44a and 44b.
is provided. Furthermore, both support arms 44 a, 4
A cutting blade 46 is installed in an erected state between the tip portions of the blades 4b.

Furthermore, a pair of guide grooves 47a and 47b are formed on the inner circumferential surface of the tip end of the flexible tube 2 and are arranged substantially parallel to each other and spaced apart from each other. These guide grooves 47a, 47b are arranged on both sides of the side hole 40. And these guide grooves 47a,
As shown in FIG. 14, the support arms 44a and 44b of the knife portion 43 are respectively inserted into the 47b. When the operation wire 42 is slid, the knife portion 43 is driven back and forth in the axial direction while the support arms 44a, 44b are guided by the guide grooves 47a, 47b.

Next, the operation of the above configuration will be explained.

First, the flexible tube 2 of the biopsy tool 1 is orally inserted into the esophagus 24, and then the insertion section 5 of the endoscope 4 is inserted into the flexible tube 2 while the balloon 19 is deflated. Insert into the insertion channel 6. Next, the flexible tube 2 is pushed forward under observation with the endoscope 4 and guided to the target site. At this time, the distal opening of the flexible tube 2 is brought into contact with the wall surface within the esophagus 24 to close the distal opening of the flexible tube 2. In this state, the piston 23 of the syringe 22 is pushed in the C direction to inflate the balloon 19. Furthermore, by closing the switching cock 21 in this state, one balloon is maintained in an inflated state. As a result, the gap between the endoscope 4 and the flexible tube 2 is closed by one balloon, thereby airtightly partitioning the front end side space and the rear end side space with one balloon in between.

In this state, when the air in the distal space is suctioned through the forceps channel 14 of the endoscope 114, the esophageal wall 24a at the target site is suctioned into the flexible tube 2 through the side hole 40 of the flexible tube 2. . Then, the forceps 1 grasp the esophagus wall 24a at the target site sucked into the flexible tube 2 by this suction action.
5, and the esophagus wall 24a is lifted up using the gripping forceps 15 as shown in FIG. Furthermore, in this state, the operation handle 11 is slid while applying a high frequency current to the high frequency force cutter 41, and the knife portion 4
3 is pushed out from the proximal side to the distal side while being guided by the guide grooves 47a, 47b of the flexible tube 2, and the root portion of the esophagus wall 24g is cauterized and cut by the cutting blade 46.

Therefore, in the case of the above configuration, the esophagus wall 2 of the target site
4a into the inside of the flexible tube 2 through the side hole 40 of the flexible tube 2, it is possible to prevent the muscle layer 33 below the mucous membrane layer 32 from being lifted up, as in the second embodiment. can. Therefore, since only the mucous membrane layer 32 can be cut and collected, there is no risk of damaging the muscular layer 33 and causing bleeding, thereby increasing safety.

Further, since the knife portion 43 of the high-frequency cutter 41 is slidably supported by the guide grooves 47a and 47b of the flexible tube 2, the knife portion 43 can be stably moved forward and backward during the cutting operation of the esophageal wall 24a. . Therefore, the esophageal wall 24a
Since there is no risk of unnecessary resection of the esophageal wall 24a other than the target area during the resection operation, operability and safety can be further improved.

Further, in the fourth embodiment, the cutting blade 46 of the knife portion 43 in the high-frequency cutter 41 is shown as having a substantially straight shape, but as shown in FIG. The cutting edge 46' may also be used.

Furthermore, in the fourth embodiment, the guide groove 47 is provided in the flexible tube 2.
a. 47b, and these guide grooves 47a, 47b
18 shows a structure for guiding the support arms 44a and 44b of the knife portion 43 in the high-frequency cutter 41, but as shown in FIG. 5 lbs may be provided in a protruding manner, and the high-frequency power cutter 52 may be guided by these guide protrusions 51a and 51b.

It should be noted that the present invention is not limited to the above embodiments, and it goes without saying that various modifications can be made without departing from the spirit of the invention.

[Effects of the Invention] As described above, according to the present invention, tissue in a body cavity is attracted to the opening of a flexible tube, the tissue is pinched with a gripping tool to make it easy to cut, and then the tissue is cut with a cutting tool. Since the tissue is picked up with a grasping tool and collected, it is easy to cut the tissue, and the base of the picked up tissue can be reliably and easily cut, and the roughly flexible tube suppresses movement of the body cavity. , a series of operations can be performed easily. From the above, it is possible to easily and reliably collect a large amount of tissue.

[Brief explanation of the drawing]

1 to 5 show a first embodiment of the present invention, in which FIG. 1 is a longitudinal sectional view of the entire biopsy device, and FIGS. 2 to 5 show a first embodiment of the present invention.
The figure is a longitudinal sectional view showing the operating procedure during a biopsy, FIGS. 6 to 9 show a second embodiment of the present invention, and FIG. 6 is a longitudinal sectional view showing the configuration of the main parts of the biopsy tool. 7 is a longitudinal sectional view of the tip of the biopsy tool, FIG. 8 is a side view of the tip of the biopsy tool, FIG. 9 is a longitudinal sectional view of the main parts showing the state of use, and FIG. 10 is a conventional biopsy tool. FIG. 11 is an enlarged sectional view of the inspection part, FIG. 11 is a vertical sectional view of the main part showing the third embodiment of the present invention, and FIGS. 12 to 16 are the fourth embodiment of the present invention. Fig. 12 is a longitudinal cross-sectional view showing the configuration of the main parts of the biopsy tool, Fig. 13 is a longitudinal cross-sectional view of the tip of the biopsy tool, Fig. 14 is a cross-sectional view taken along line A-A in Fig. 13, and Fig. 15 is a longitudinal cross-sectional view of the tip of the biopsy tool.
16 is a sectional view taken along line C-C in FIG. 13, FIG. 17 is a vertical sectional view of main parts showing a modification of the fourth embodiment, and FIG. FIGS. 19 and 20 are longitudinal sectional views of main parts showing still another modification of the fourth embodiment, and side views of conventional examples at the time of biopsy, respectively. 1... Biopsy tool, 2... Flexible tube, 4... Endoscope, 8
...Treatment instrument insertion channel, 9...High frequency snare (
cutting tool) 14... forceps channel (intake means) 15
... Grasping forceps (gripping tool) 19... Balloon (obstruction means) 24a... Esophageal wall, 35... First treatment instrument insertion channel, 36... Second treatment instrument insertion channel, 38 ...3 high-frequency needle-like scalpels (cutting tools)...
Blocking valve (blocking means), 41... High frequency power ivy (cutting tool).

Claims (1)

[Claims] A biopsy instrument that is used by inserting an endoscope, a gripping tool for pinching living tissue, and a cutting tool for cutting the tissue into a flexible tube, the biopsy tool being provided in the flexible tube and having the gripping tool or cutting tool installed in the flexible tube. a treatment instrument insertion path through which at least one of the instruments is inserted; a suction means for sucking air in the space on the distal end side of the flexible tube; and a means for closing a gap between the endoscope and the flexible tube. A biopsy device characterized in that it is equipped with a closure means.