JPH05184535A - Multifunctional treating-implement - Google Patents

Abstract

PURPOSE:To save the time required for changing a treating implement, and to shorten the treatment time by arranging plural built-in treating implements in the tip part of a main body catheter, and operating independently each treating function part, respectively. CONSTITUTION:A multifunction treating implement 10 is formed by containing plural built-in treating implements in a main body catheter 12, and for instance, provided with a grip forceps 14, two pieces of clip forceps 16, a high frequency electric surgical knife 18 and an injection needle 20. These built-in treating implements can move forward and backward separately treating function parts of the respective tip parts, and also, can operate independently each treating function part, respectively. That is, they are moved forward and backward independently, and also, can be rotated centering around its own axes, and moreover, can be rotated integrally in the main body catheter 12, and furthermore, a necessary operation can be executed by curving the tip independently. In such a way, it is unnecessary to change the treating implement required for the treatment each time, and an exact treatment can be executed in a short time.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical multifunctional treatment instrument having a plurality of treatment functions.

[0002]

2. Description of the Related Art Generally, in the case of a surgical operation for treating a required site in the body by an operation from the outside of the body or a biopsy, a large number of treatment tools such as scissors forceps or a scalpel may be used. .. Each of these treatment tools has a single function, and is inserted into the body through an insertion guide tool such as an endoscope as necessary. After performing the required treatment, the unnecessary treatment tool is pulled out of the body, and then the treatment tool necessary for the next treatment is inserted into the body.

[0003]

By the way, when it is necessary to perform treatment using a large number of treatment tools, a treatment tool suitable for the treatment is inserted each time the treatment tool is inserted and the insertion guide tool has a narrow insertion width. It is necessary to carefully guide to the required site through the channel. Especially when it is used by inserting it deep into the lumen,
It takes time and labor to replace the treatment tool. For this reason,
Prolongs treatment time.

The present invention has been made in view of the above problems, and an object of the present invention is to eliminate the time required for exchanging a treatment tool when performing treatment using a plurality of treatment tools.
It is to provide a multi-function treatment tool capable of shortening the treatment time.

[0005]

According to the multifunctional treatment instrument of the present invention, a plurality of built-in treatment instruments are arranged at the distal end portion of the main body catheter to be inserted into the body, and each treatment function portion is independently provided. It is designed to operate.

[0006] In this multi-function treatment instrument, the distal end portion is inserted into a required site in a body cavity, a built-in treatment instrument having a function suitable for the treatment to be performed is selected, and the required treatment can be performed. This eliminates the need to replace various treatment tools. Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

[0007]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 shows the vicinity of the distal end of a multi-functional medical treatment instrument 10 according to an embodiment of the present invention.

This multi-function treatment instrument 10 is suitable for excision of the gallbladder, and is formed by accommodating a plurality of built-in treatment instruments in a long main catheter 12. As these built-in treatment tools, the gripping forceps 14 and 2 are used in the multifunctional treatment tool 10 of the present embodiment.
Book clip forceps 16, high frequency electric knife 18, and injection needle 2
0 and are provided. These built-in treatment tools are capable of individually advancing and retracting the treatment function portions of the respective distal end portions, and each of the treatment function portions can be operated independently. The clip forceps 16 may be replaced with a suturing device, and the injection needle 20 may be replaced with a catheter.
Further, it is obvious that the number and function of these built-in treatment tools can be appropriately changed depending on the treatment target, the treatment method, and the like.

FIG. 2 shows a state in which the gallbladder 200 having a stone is excised by using the multi-function treatment instrument 10. Code 20
2 is a bile duct, and 204 is a common bile duct. When the gallbladder 200 is resected using the multifunctional treatment instrument 10, the multifunctional treatment instrument 10 is guided into the body through the insertion guide while swelling the body cavity and observing the affected area with an endoscope or the like. Is placed near the gallbladder duct 202. After this,
The gallbladder 200 can be resected according to the procedure described below.

That is, the grasping forceps 14 is shown in (B1) of FIG.
As exemplified by the clip forceps 16, the multi-functional treatment instrument 10 allows all of the built-in treatment instruments in the main body catheter 12 to independently advance and retreat and rotate about its own axis, and these built-in instruments are also included. The treatment tool can be rotated as a unit in the main body catheter 12,
Further, these built-in treatment tools can be individually curved at their tips to perform required operations.

To remove the gallbladder 200, first, as shown in (A1) of FIG. 3, the grasping forceps 14 is advanced from the tip of the main body catheter 12 to grasp the portion of the gallbladder tube 202 to be cut. Close. Then, while holding the gallbladder duct 202 with the grasping forceps 14, the injection needle 20 is advanced to be inserted into the gallbladder duct 202, and the gallbladder 200
Inject contrast agent into. By injecting this contrast agent, it is possible to obtain information necessary for subsequent processing regarding the size and distribution of stones in the gallbladder 200 through an X-ray radiographic image.
After the injection of the contrast agent is completed, the injection needle 20 is retracted,
Position it so that it does not interfere with later treatment. It is preferably retracted and stored in the main catheter 12.

Next, as shown in (A2) and (B2) of FIG. 3, the first clip forceps 16 is moved forward, and the portion separated from the gallbladder 200 by the clip 17 is more than the portion grasped by the grasping forceps 14. After closing and placing the clip 17 in place as shown in (A3) and (B3) of FIG.
The first clip forceps 16 can be retracted. Further, as shown in (A3) of FIG. 3C, the second clip forceps 16 'on the opposite side is advanced, and similarly, the gallbladder duct 202 is closed by the clip 17. In addition, when the first clip forceps 16 holds a plurality of clips 17 and sequentially performs the clipping operation, or when the second clip forceps 16 ′ is arranged adjacent to the first clip forceps 16, After clipping with the clip forceps 16, the gripping forceps 14 is released from the gallbladder canal 202, retracted, rotated to a required position, and then a clipping operation is performed.

In this way, after closing the gallbladder duct 202 at two points with the clip 17, the high-frequency electric scalpel 18 is advanced to cut the closed portion with the clips 17, 17. The state of being cut in this way is shown in (A5) of FIG. Since the gallbladder duct 202 cuts the site between the two portions blocked by the clips 17 and 17, the contents of the gallbladder 200 or the common gallbladder duct 204 will not leak into the body cavity.

4 and 5 show grasping forceps 2 which can be used as a built-in treatment tool of such a multifunctional treatment tool 10.
2 is shown. As shown in the figure, the gripping forceps 22 includes a chuck unit 24 arranged in an outer cylinder unit 23 and a knife unit 25 arranged in the chuck unit 24.
And a high frequency electrode is formed on the tip portion 25a of the knife unit 25. Furthermore, this knife unit 2
A guide groove 24a is formed in the front end of the chuck unit 24 that holds the front end 25a of No. 5, and the guide groove 24a guides the front end of the knife unit 25.

The gripping forceps 22 has both a clip function and a knife function, so that the function of the multi-function treatment instrument 10 can be enhanced, and the distal end portion 25a, which is a high-frequency knife, is guided in the guide groove 24a to advance and retreat. Therefore, the sniper property of the knife can be improved.

FIG. 6 shows a linear actuator for advancing and retracting such a built-in treatment instrument. In this embodiment, the grasping forceps 14 is illustrated as being used for controlling the forward / backward movement, but other forceps such as a scalpel, that is, a built-in treatment tool can be similarly forward / backward controlled.

The linear actuator 26 shown in FIG. 6 is formed as a cylinder-piston unit, and a piston 28 is slidably guided in the cylinder portion 27. An operating rod 14a of the grasping forceps 14 is connected to the piston 28, and a liquid 29, such as liquid paraffin or freon, which is easily boiled by heating is contained in the operating chamber defined by the piston 28 in the cylinder portion 27. There is. A coil-shaped heater 30 is arranged around the working chamber containing the liquid 29.

With this linear actuator 26, the operating rod 1
When extending 4a, a current is supplied to the heater 30. Due to the heat generation temperature at this time, a part of the liquid 29 evaporates, and the pressure of the vapor 29a causes the piston 28 to move in a direction to expand the working chamber. When pulling in the operating rod 14a, the heating of the heater 30 is stopped and the steam 29a is cooled and returned to the liquid 29. If necessary, a cooling device may be provided to forcibly cool. 6A shows a state in which the operating rod 14a is retracted, and FIG. 6B shows a state in which it is extended.

FIG. 7 shows a linear actuator 26a according to another embodiment. This linear actuator 26a uses electrostatic attraction. As shown in the figure, the operating rod 14a is arranged in the guide hole 31 formed in the sheath or the like, and the plurality of rollers 33 roll between the inner wall of the guide hole 31 and the operating rod 14a. There is. Furthermore, a large number of linear electrodes 32 are provided on the inner wall of the guide hole 31.
It is embedded along the axial direction of a. These linear electrodes 3
2 can be formed by etching, for example.

The linear actuator 26a
When moving the operating rod 14a by
A voltage is sequentially applied to the linear electrode 32 along the direction in which a is to be moved. As a result, charges are generated on the surface of the roller 33 which is close to the linear electrode 32 to which a voltage is applied, and an electrostatic attractive force as indicated by an arrow 34 is sequentially formed between the linear electrode 32 and the linear electrode 32. The roller 3 by this electrostatic attraction 34
With the rotation of 3, the operating rod 14a moves. When moving the operating rod 14a in the reverse direction, a voltage is sequentially applied to the linear electrode 32 in the reverse direction.

FIG. 8 shows a modification of the embodiment shown in FIG. 7. This linear actuator 26b has a superconducting thin film 36 formed on the surface of the guide hole 31, and a thin film 35 of a permanent magnet formed on the surface of the operating rod 14a by sputtering or the like. Is installed.

When the linear actuator 26b is brought into a superconducting state, the actuating rod 14a floats due to the Meissner effect. In this state, the linear actuator 2 of FIG.
When a voltage is sequentially applied to the linear electrode 32 similarly to 6a, the operating rod 14a moves along the axial direction. According to the linear actuator 26b of this modified example, the roller 33 (FIG. 7) that supports and drives the operating rod 14a is unnecessary, and friction does not occur.

FIG. 9 shows an embodiment of an operating mechanism for gripping the gripping arm 37 of the gripping forceps. In this embodiment, the gripping arms 37, 37 are made of a shape memory alloy. The gripping operation and the releasing operation can be performed by electrically heating these gripping arms 37, 37 to change their shapes. (A) in the figure
Indicates that the gripping arms 37, 37 are individually controlled, and (B) in the figure indicates that both are controlled simultaneously. In the figure, the solid line shows the released state and the dotted line shows the gripped state.

FIG. 10 shows an embodiment of the gripping arm 38 which operates by using the difference in the coefficient of thermal expansion between different materials. Each arm body 38a is made of a resin such as polyimide and has a claw shape. The metal pattern 3 is formed on the outside of each arm body 38a.
8b is provided. When the metal pattern 38b is energized to generate heat, each arm main body 3 has a different thermal expansion coefficient.
8a is curved in the direction in which they come close to each other. When returning to the original state, stop energizing and cool. The arm body 3
8a may be formed of a metal, and in this case, a metal material different from the metal pattern 38b is used.

The gripping arm 39 shown in FIG. 11 is formed in a hollow structure as shown in FIG. A liquid 42 which is easily vaporized or expanded by heating, for example, liquid paraffin or CFC is contained in the inner hole of the base 40 communicating with the hollow portion, and the heater 41 is provided around the inner hole containing the liquid 42. Is buried. Further, as shown in FIG. 3B, the hollow portion of the gripping arm 39 is eccentrically arranged outside the gripping arm 39, and therefore, the outer side of each gripping arm 39 is formed in a thin structure, and the inner side is formed. The structure is thicker than these.

When operating the gripping arm 39, the heater 41 is energized to heat the liquid 42 to expand or vaporize it. As a result, the outer side of the thin-walled structure of the grip arm 39 extends more than the inner side, and the state shown in FIG. When the heating by the heater 41 is stopped and the liquid 42 is cooled, the state shown in FIG.

A magnetic fluid may be used instead of the vaporizable or expandable liquid 42. In this case,
An electromagnetic coil can be provided instead of the heater 41, and the magnetic fluid can be operated depending on the direction of the magnetic flux generated by the electromagnetic coil.

FIG. 12 shows a rotating mechanism that integrally rotates the above-described various built-in treatment tools in the main body catheter 12. In the multi-function treatment instrument 10 of this embodiment, a built-in treatment instrument such as grasping forceps and a scalpel is rotatably accommodated in the main body catheter 12 as a built-in unit 43. The built-in unit 43 is rotated about the axis of the main body catheter 12 by an ultrasonic motor 44 arranged in the main body catheter 12.

In order to reduce friction between the inner wall of the main body catheter 12 and the outer wall of the built-in unit 43, a roller having a small diameter (not shown) is arranged between the inner wall of the main body catheter 12 and the outer wall of the built-in unit 43. May be. Alternatively, a thin film of a permanent magnet may be arranged on the inner wall of the main body catheter 12, a superconducting thin film (at room temperature) may be arranged on the outer wall of the built-in unit 43, and the built-in unit 43 may be lifted from the main body catheter 12 by the Meissner effect. ..

FIG. 13 shows a multifunctional treatment instrument 5 according to the second embodiment.
Indicates 0. The multi-function treatment tool 50 includes a main body catheter 52.
Inside, a built-in block 56 on which a plurality of built-in treatment tools are respectively mounted is arranged. These built-in blocks 5
4, 56 are formed in a rectangular shape, the built-in block 54 has the gripping arm 15 and the high-frequency knife 19, and the built-in block 56 has the gripping arm 15 and the injection needle 21. The reference numeral 21a sends the liquid medicine to the injection needle 21,
Alternatively, it is a liquid supply tube for suctioning.

These built-in blocks 54, 56 are arranged in the state of FIG. 13B in the state of FIG. After moving the built-in blocks 54 and 56 in parallel from such a state,
When the built-in block 56 is moved forward, it can be expanded to the state shown in FIG. The overall movement of the built-in blocks 54, 56 can be performed by an operating mechanism (not shown).

As shown in FIG. 13A, each of the built-in blocks 54 and 56 is formed with a groove along the longitudinal direction thereof, and a minute micropinion 58 is arranged in this groove. These micro pinions 58 are adapted to mesh with a rack gear formed on the inner wall of each groove. The micropinion 58 of the built-in block 54 is rotationally driven by the ultrasonic motor 51 via the shaft 55 as shown in FIGS. (B) and (C), and similarly, the micropinion 58 of the built-in block 56 is passed through the shaft 57. Ultrasonic motor 5
It is driven to rotate at 1. Further, the built-in block 56 accommodated inside the main body catheter 52 can be advanced and retracted in the axial direction together with the shaft 57 by the linear actuator 53. The linear actuator 53 is of a piston-cylinder type, but it is also possible to use a linear actuator as shown in FIGS. 7 and 8 or another actuator.

When using the multi-function treatment tool 50 of this embodiment, the built-in blocks 54 and 56 are extended from the states shown in FIGS. 13 (A) and 13 (B). Next, the ultrasonic motor 51 rotates the micro pinion 58 via the shaft 55, and moves the built-in block 54 in parallel to the state of FIG. Finally, the linear actuator 53
In this way, the built-in block 56 is moved forward, and the micropinion 58 is rotated via the shaft 57, and the state shown in FIG. As a result, similar to the multi-function treatment instrument 10 shown in FIG. 1, the required treatment can be performed using each built-in treatment instrument. It should be noted that instead of the micro pinion 58 and the rack gear formed on the inner wall of the groove, an ultrasonic linear motor or an electrostatic linear motor is used to each built-in block 54, 5
6 may be expanded.

FIG. 14 shows a multi-functional treatment instrument 60 according to a modification. In this multi-function treatment instrument 60, as shown in FIG. 14A, built-in blocks 64 and 66 housed in a main body catheter 62 are arranged such that the built-in treatment tools mounted on each block face each other. The built-in block 64 has a hinge 65 formed of a shape memory alloy and is provided with a main catheter 6
It is attached to the tip of 2 and has a built-in block 6
6 can be moved back and forth with respect to the main body catheter 62 by a linear actuator (not shown) via a shaft 67. When the hinge 65 is heated,
The portion to which the built-in block 64 is attached is formed so as to bend from the state shown in FIG. 3A to the state shown in FIG. 2B and to return to the original state when cooled.

When using this multi-function treatment tool 60,
The hinge 65 is heated by an appropriate heating means, and the built-in block 6
4 is expanded to the state of FIG. Next, the shaft 67 is extended and the built-in block 66 is advanced from the main body catheter 62. Accordingly, it can be used in the same manner as the multifunctional treatment tool 50 of FIG. The same parts as those in the embodiment of FIG. 13 are designated by the same reference numerals and the description thereof is omitted.

Therefore, these multifunctional treatment tools 10,
It is possible to perform the required treatment such as excision of the gallbladder 200 extremely quickly and accurately using any of 22, 50 and 60. Next, a case where a multifunctional treatment tool is inserted into the gallbladder 200 to treat stones will be described.

In the case of treating such a gallbladder stone, as shown in FIG. 15, the multifunctional treatment instrument 70 is passed from the duodenum 210 to the Vater papilla 212 through the insertion channel of the endoscope 1 which is preferably of the side-view type. Through the common bile duct 20
Insert in 4. Then, this common bile duct 204 is inserted into the gallbladder 200 via the gallbladder duct 202, and the tip end portion thereof is placed near the calculus 208 as shown in the drawing. This multi-function treatment instrument 70 is formed to have a small diameter so that it can pass through Mr. Ferter's papilla 212 without any treatment at the time of insertion. Reference numeral 206 is a liver. FIG. 16 shows details of the vicinity of the distal end portion of the multi-function treatment instrument 70 suitable for the treatment of such a gallbladder stone 208.

As shown in FIG. 16, the multi-functional treatment instrument 70 in this embodiment has three main body catheters 72 in which three elongated gripping arms 73 and an electric head 74 for calculus crushing called an EHL head can be freely moved back and forth. Accommodate. The gripping arm 73 is made of a material having a spring property, and the main body catheter 72 is formed by a linear actuator (not shown).
When projected from, it is bent into a shape suitable for gripping a calculus 208 (FIG. 15).

Further, an optical scope 75 is arranged at a substantially central portion of the multi-function treatment instrument 70, and the main body catheter 7 is provided.
A bending mechanism 76 made of, for example, a shape memory alloy wire is embedded in a portion close to the outer peripheral portion of 2. Therefore, by direct observation with the optical scope 75 and inserting while operating the bending mechanism 76, it is possible to easily insert even into a meandering luminal organ deep inside the body as shown in FIG.

FIG. 17 shows a state in which the calculus 208 is crushed by such a multifunctional treatment tool 70. First, scope 7
While observing the state of the calculus 208 in FIG. 5, the gripping arm 73 is advanced from the tip of the main body catheter 72 by a linear actuator as shown in FIG.
The calculus 208 is gripped by the three gripping arms 73 as shown in FIG. After this, as shown in FIG.
Is advanced to apply a high voltage between the electrodes on the tip surface of the electric shock head 74 to cause discharge, and the calculus 208 is crushed by the impact at the time of this discharge.

Although the calculus 208 has various shapes, it is possible to grip the calculus 208 at an optimum position by moving the gripping arms 73 as shown by the arrows in FIG. At this time, the position of the gripping arm 73 can be controlled according to the state of the calculus 208 by observing the calculus 208 through the scope 75.

Further, instead of the electric shock head 74 for crushing the calculus 208, a built-in treatment tool as shown in FIGS. 19 and 20 can be provided. The multifunctional treatment tool 70a in FIG. 19 is provided with a crushed stone drill head 77, and the multifunctional treatment tool 70b in FIG. 20 is provided with a crushed stone laser fiber 78. Further, the multifunctional treatment instrument 70b of FIG. 20 is provided with a spectroscopy fiber 79 in place of the direct-viewing optical scope 75. These multifunctional treatment tools 70a,
70b can be used similarly to the multi-function treatment instrument 70. It should be noted that in the modified example of FIGS. 19 and 20, FIG.
The same parts as those of the multi-functional treatment instrument are designated by the same reference numerals, and detailed description thereof will be omitted.

FIG. 21 shows a bending mechanism of the multi-function treatment instrument 70. As shown in FIGS. 21A and 21B, this bending mechanism has four shape memory alloy wires 76 arranged at equal intervals in the circumferential direction in the vicinity of the outer circumference of the main body catheter 72. Each shape memory alloy wire 76 of the main catheter 7
2 is extended along the longitudinal direction. Further, as shown by the dotted lines in FIGS. 16, 19 and 20, each shape memory alloy wire 76 is formed in the shape of an elongated U-shape in the longitudinal direction that is folded back near the distal end of the main body catheter 72 as a whole. .. Further, as shown in FIG. 21 (A), these shape memory alloy wires 76 are formed in a wavy shape having a large number of small curved portions and extend linearly when heated.
It is preferable that these shape memory alloy wires 76 are arranged in a groove extending in the main body catheter 72 so as not to disturb the shape deforming operation. When arranging the shape memory alloy wire 76 in the predetermined groove as described above, it is desirable that each shape memory alloy wire 76 is fixed to the main body catheter 72 at the tip end thereof with an adhesive or the like.

Reference numeral 80 indicates a gripping arm passage, reference numeral 81 indicates an electric shock head passage, and reference numeral 82 indicates a scope passage. If necessary, the image guide and the light guide may be provided on the outer peripheral side of the gripping arm passage 80 or at a suitable portion such as between the gripping arm passages 80.

When a current is supplied to such a shape memory alloy wire 76 through a current-carrying wire (not shown) to generate heat, the shape memory alloy wire 76 extends linearly due to the heat, and therefore, the main body catheter 72 is set to the shape shown in FIG. It is curved as shown in (C). By selecting the shape memory alloy wire 76 to be electrically heated, the main body catheter 72 can be bent in a desired direction. FIG. 22 shows a multifunctional treatment instrument 70c according to still another modification. This multi-function treatment instrument 70c has a plate-shaped gripping arm 83 as shown in FIG.

As shown in FIG. 22B, ceramic piezoelectric members 84 and 85 are attached to the tip portion of the gripping arm 83 to form a bimorph structure. This piezoelectric body 8
4, 85 can also be formed by vapor deposition or by applying a piezoelectric ceramic material to the surface of the gripping arm 83 and then baking it. Although the piezoelectric bodies 84 and 85 in FIG. 22 are bimorphs, they may be monomorphs.

Since a high voltage of, for example, about 100 to 500 VDC is applied to the piezoelectric bodies 84 and 85 provided on the gripping arm 83, it is necessary to cover the outer surfaces of the piezoelectric bodies 84 and 85 with the coating 86. The state of being covered with the coating 86 in this manner is shown in FIG.

With this gripping arm 83, a stone 208 (see FIG.
When gripping 5), each gripping arm 83 is moved forward while observing calculi with the scope 75, as in the above-described embodiment,
After reaching the required position, a voltage is applied to the piezoelectric bodies 84 and 85 through a current-carrying wire (not shown) to extend the piezoelectric body 84 and contract the piezoelectric body 85 as shown in FIG. As a result, each gripping arm 83 bends and grips the calculus. Therefore, these multifunctional treatment tools 70,
Any of 70a, 70b, 70c can treat the calculus 208 extremely quickly and accurately.

Next, an example of a multifunctional treatment tool used for cell manipulation will be described. As shown in FIG. 23, the multi-function treatment instrument 90 of this embodiment can be inserted into the fallopian tube 222 via the vagina 220, and can be bent like the multi-function treatment instrument of each of the above embodiments. Has been formed.
The multi-function treatment instrument 90 shown in FIG. 23 has a vaginal egg collection for artificial fertilization outside the body, a vaginal intraocular fertilization egg implantation,
And it can be used for therapeutic gene transfer to any cells for the treatment of genetic disorders. In FIG. 23, reference numeral 224 indicates a fallopian tube, reference numeral 226 indicates an ovary, reference numeral 228 indicates a uterine body, and reference numeral 230 indicates a cervix.

FIG. 24 shows a state in which the fertilized egg is grasped by the three grasping arms 94 of the multifunctional treatment instrument 90. The gripping arm 94 may be formed in a bendable manner by providing a bimorph piezoelectric body at the tip end thereof, as in the above-described embodiments.

The multi-function treatment instrument 100 shown in FIG. 25 is adapted to grasp an ovum by utilizing the negative pressure formed by the flow of fluid. This multi-function treatment instrument 100 has a fluid passage 103 that opens to the distal end surface inside a main body catheter 102, and pressurized air is sent from a pump 104 through this fluid passage 103. On the tip end surface of the main body catheter 102, a guide 1 having a substantially conical shape is formed around the opening of the fluid passage 103.
05 is arranged. This guide 105 has a fluid passage 1
The air ejected from the opening of the tip surface through 03 is guided along this inner surface to form an air flow indicated by reference numeral 106 between the guide 105 and the egg 232 as shown in FIG. The egg 232 is gripped by the negative pressure generated by the air flow 106.

The air sent from the pump 104 is sterile air, and physiological saline may be sent instead of this sterile air. Further, instead of the negative pressure due to such a fluid flow, it is also possible to grasp by utilizing laser trapping due to light pressure. In this case, the main catheter 10
An optical fiber for guiding a laser is installed in the inside 2.

Further, a needle 107 and a micro pump unit 109 are provided in the main body catheter 102 of the multi-function treatment instrument 100. In addition, the main body catheter 10
A small hole 108 through which the needle 107 is inserted when the needle 107 and the micropump unit 109 are advanced in the main body catheter 102 is provided at the distal end of 2, and a notch is formed in the guide 105. There is. The micropump unit 109 may be of any type, and FIG. 26 shows an embodiment of such a micropump unit 109.

As shown in FIG. 26A, the micropump unit 109 of this embodiment has a capillary tube 110, and a heater 112 is arranged around the capillary tube 110. As shown in FIG. 26B, the micro pump unit 109 draws in the fluid by utilizing the capillary phenomenon and heats the capillary tube 110 by the heater 112, at which time bubbles are generated or the fluid is expanded and discharged. To do.

FIG. 27 shows an embodiment of a multifunctional treatment instrument 120 according to still another embodiment used for cell manipulation. As shown in (A) of the same figure, this multi-function treatment tool 120 accommodates a grasping arm 124 in a main body catheter 122 so as to be able to move forward and backward, and from four memory alloy wires 126 extended in the main body catheter 122. It is possible to bend freely by the bending mechanism.

Further, a syringe unit 128 including an injection needle 129 is accommodated in the main body catheter 122. The syringe unit 128 can be moved forward or backward in the main body catheter 122 by a syringe drive unit 138. The syringe drive unit 138 can move together with the gripping arm 124, and the drug in the syringe unit 128 contains the inertial body 130, the magnet 132, and the laminated piezoelectric body 1 housed therein.
And an operating unit 136 including an injection needle 129
Can be released via. This syringe drive unit 138 is shown in FIG.
29 and the operating state of the operating unit 136 thereof are shown in FIG.

An egg 232 is produced by this multi-function treatment instrument 120.
When injecting a drug into, do as follows. First, the grasping arm 124 is moved by hand so that the tip 125 of the grasping arm 124 is projected from the main body catheter 122, and this is curved to make the egg 2
Hold 32. This state is shown in FIG. The egg 232 may be gripped by the grip arm 124 by providing the tip portion 125 of the grip arm 124 with, for example, a bimorph piezoelectric body as shown in FIG.

Next, as shown in FIG. 27C, the syringe drive unit 138 drives the syringe unit 12
8 is advanced and the injection needle 129 at this tip is pierced into the egg 232. Thereafter, the actuation unit 136 injects the drug inside.

As shown in FIG. 28, the syringe drive unit 138 has a bellows-shaped expansion / contraction part 141 at both axial ends.
A pressing member 140 having a and 141b and containing a magnetic fluid 142 therein is provided. The pressing member 140 is formed of, for example, plastic, and the expansion / contraction parts 141a, 141
Magnetic fluid 14 by the magnetic field of coil 144 mounted between b
By moving 2, the syringe unit 128 can be moved back and forth. This coil 144 is hardened with resin, and
It is integrally fixed to the inside of the gripping arms 124, 124. Therefore, when the gripping arm 124 moves, it moves with it, and moves the syringe unit 128 via the expansion / contraction part 141a.

When advancing the syringe unit 128, as shown in FIG. 28, the coil 144 is excited through a current-carrying wire to form a magnetic field in a predetermined direction. As a result, the magnetic fluid 142 in the pressing portion 140 is expanded and contracted by the expansion and contraction portion 141.
When moving to the a side, the elastic portion 141b contracts and the elastic portion 14
1a extends and the syringe unit 128 advances. FIG. 27C shows this state. When the syringe unit 128 is moved in the reverse direction, a reverse magnetic field is formed in the coil 144, and the expansion / contraction part 141a to the expansion / contraction part 14 are formed.
Move the magnetic fluid to 1b.

As shown in FIG. 29, a syringe unit 128 for injecting a drug is formed by accommodating an operating unit 136 in a syringe body 127 and discharging the internal drug from an injection needle 129 by this operating unit 136. is there. The inertial body 130 of the operating unit 136 partitions the drug chamber 135 into the syringe body 127, and when not operating, as shown in (A) of FIG. 29 and (A), (B), (C) of FIG. 27, The inertial body 130 is attracted to the laminated piezoelectric body 134 by the magnet 132.

Then, when a pulse voltage is applied to the laminated piezoelectric material 134 via a current line (not shown), the laminated piezoelectric material 134 is suddenly deformed, and the inertial body 130 attracted by the magnet 132 is released by inertial force. Drug chamber 1 with this momentum
The drug in 35 is discharged through the injection needle 129. This state is shown in FIGS. 29B and 27D.

FIG. 30 shows a modified example of the syringe unit. The syringe unit 148 shown in FIG.
Has a stepped bore formed in the syringe body 147,
A piston 150 reciprocally housed in this large-diameter inner hole
Thus, the medicine chamber 155 is defined on the large diameter inner hole side, and the pressure chamber 153 is defined on the opposite small diameter inner hole side. The drug chamber 155 communicates with the injection needle 149, and the pressure chamber 153 contains a gas or liquid 152 that easily boils when heated, for example, liquid paraffin or freon. Further, a heater 154 for heating the liquid 152 is arranged around the small diameter inner hole.

According to this syringe unit 148, when the heater 154 is energized to heat the liquid 152, the liquid 1
52 expands or vaporizes, and the pressure at this time moves the piston 150 to the left in FIG. 30, and the drug in the drug chamber 155 is released through the injection needle 149.

The syringe unit 1 shown in FIG. 30 (B).
48a is substantially the same as the syringe unit 148, except that the syringe unit 148a of this modified example has a medicine chamber 157 and a pressure chamber 159 defined by a bag body 156 made of an elastic material. In the syringe unit 148a of this modified example, when the liquid 152 in the pressure chamber 159 expands, the bag body 156 contracts, and the drug in the bag body 156 is discharged via the injection needle 149. The syringe unit 1 in FIG.
The same reference numerals are given to the same portions as 48, and the description thereof will be omitted.

FIG. 31 shows a syringe unit 168 according to still another embodiment, in which a piezoelectric body 162 formed in an annular shape is arranged around the syringe body 160. The piezoelectric body 162 is formed so as to expand and contract in the radial direction, and when a voltage in a predetermined direction is applied via a current line (not shown), the piezoelectric body 162 contracts and contracts the syringe body 160 in the radial direction. As a result, the drug in the syringe body 160 is released from the tip opening 161. Therefore, each of the multi-function treatment tools 90, 100, 120 can promptly and reliably perform a required cell operation. 32 shows
An example of a multifunction catheter applicable to strip biopsy is shown.

The multi-function catheter 170 of this embodiment is
As a built-in treatment tool, grasping forceps 174, an injection needle 176, and a micro snare 178 are housed in the main body catheter 172. Although not shown, an optical scope can be housed in the same manner as the multifunction catheter of each of the above embodiments.

The function of each built-in treatment instrument in the present embodiment is the same as that of a normal one, and the operation or drive mechanism for advancing and retracting or rotating the same can be the mechanism according to each of the above-mentioned embodiments or modifications. ..

The strip biopsy is performed by the multi-function catheter 170 as follows. First, as shown in FIG. 33 (A), the injection needle 176 is moved forward by a linear actuator (not shown), and the injection needle 1
Insert 76 into tissue 240. Ethanol is injected into the tissue 240 through the injection needle 176 to elevate the required site as indicated by reference numeral 242. Then, the grasping forceps 17
4 is advanced and the tissue 24 raised by this gripping arm
Grasp the root part of 2. At this time, the injection needle 176 is retracted and accommodated in the main body catheter 172. This state is shown in FIG. Then, as shown in FIG. 33C, the microsnare 178 is advanced, the raised tissue 242 is passed through the annular tip portion of the microsnare 178, and a high-frequency current is passed through the annular tip portion. This allows
The raised tissue 242 is burned off and the required inspection can be performed. Therefore, the multifunctional treatment instrument 170 can also perform a required treatment on a required site in the body extremely quickly and accurately. Finally, FIGS. 34 and 35 each show an embodiment provided with a selection mechanism for selecting a desired one from a plurality of built-in treatment tools.

The multi-function treatment instrument 180 shown in FIG. 34 has a body or main body catheter 1 as shown in FIG.
A treatment tool holder 184 is rotatably accommodated in an inner hole 182a formed at the tip of 82. Treatment tool holder 1
An electrostatic micromotor 188, for example, is installed on the outer peripheral surface of 84 and the inner peripheral surface of the inner hole 182a. The electrostatic micromotor 188 allows the treatment instrument holder 184 to freely rotate to a desired position with respect to the main body catheter 182. Can move.

In this treatment instrument holder 184, (B) in FIG.
As shown in FIG. 3, in this embodiment, three treatment tool accommodating holes 185 are formed, and a gripping arm made of a shape memory alloy is heated in the treatment tool accommodating holes 185 as shown in FIGS. 9 to 11, for example. Each of the required built-in treatment tools 186 such as a micro gripper for closing the grip arm or closing the gripping arm by fluid pressure is housed. A support portion 187 on the proximal end side of the built-in treatment instrument 186 is slidably guided while maintaining a liquid-tight or air-tight state with respect to the wall surface of the treatment instrument accommodation hole 185.
Built-in treatment instrument 186 accommodated in this treatment instrument holder 184
In addition to the above micro grippers, for example, a bipolar electrode or the like is preferable.

Further, a pressure fluid guide path 181 arranged coaxially with one of the treatment instrument accommodating holes 185 is extended in the main body catheter 182, and a built-in treatment instrument 186 is provided on the distal end wall thereof.
Is formed with a guide hole 181a. The guide hole 181a is formed to have a smaller diameter than the support portion 187 of the built-in treatment instrument 186, and the electrical contact 183 of the conducting wire 183 extending inside the main body catheter 182 is further provided on the peripheral portion thereof.
a is arranged. Then, when the distal end portion of the visceral treatment instrument 186 projects through the guide hole 186, the support portion 1
87 is locked to the peripheral portion of the guide hole 181a, and the electric contact 183a arranged on the peripheral portion of the guide hole 181a is electrically connected to the electric contact 183b arranged on the support portion 187 and controlled through the conducting wire 183. Instrument with built-in signal 18
Can be sent to 6.

Built-in treatment instrument 18 of this multi-function treatment instrument 180
In the case of treatment using No. 6, the procedure is as follows. First, the treatment tool holder 184 is rotated by the electrostatic micromotor 188 in the inner hole 182a of the main body catheter 182, and the treatment tool housing hole 185 housing the required built-in treatment tool 186 becomes the pressure fluid guide path 181 and the guide hole 181a. Arrange them so that they are coaxial. Thereafter, when pressure is applied in the direction of the arrow shown in FIG. 34 (A), the support portion 187 of the built-in treatment instrument 186 is pressed by this pressure fluid, and the treatment instrument accommodation hole 18 is formed.
5 slides, and its tip projects from the guide hole 181a. The electrical contact 183b provided on the support portion 187
Is electrically connected to the electrical contact 183a of the main body catheter 182, whereby a control signal can be sent from the outside via the conducting wire 183 and the built-in treatment instrument 186 can be operated.

As shown in FIG. 35A, the multifunctional treatment instrument 190 shown in FIG. 35 has electrodes of various shapes such as a hook electrode 196a, a spatula electrode 196b and a button electrode 196c in the present embodiment. Built-in treatment tool 19
6 are arranged along the axial direction of the main catheter 192. An insertion hole 192a for projecting the built-in treatment instrument 196 is formed on the distal end wall of the main body catheter 192 as shown in FIG. It can go in and out through the hole 192a.

Each treatment tool 196 has a support portion 198 for connecting to the shaft 194. As shown in FIGS. 35A and 35C, the supporting portion 198 has a U-shape or a U-shape in which a groove is formed between a pair of opposing wall portions, and a permanent groove is formed on the groove bottom. A magnet 197 is arranged.
Further, the shaft 194 is formed with a distal end portion that encloses the electromagnet 195 and is fitted into the groove of the supporting portion 198, and a groove that accommodates the base end side wall portion of the supporting portion 198. Electrical contact 1 of conducting wire 193 extended in 194
93a is arranged.

When performing treatment with this multi-function treatment instrument 190, the shaft 194 is advanced and retracted within the main body catheter 192, and the distal end portion is inserted into the groove provided in the support portion 198 of the required built-in treatment instrument 196. The electromagnet 195 is excited. As a result, the built-in treatment instrument 196 and the shaft 194 are firmly coupled by the permanent magnet 197 and the electromagnet 195, and the electric contact 193 a of the shaft 194 is supported by the supporting portion 198.
Is electrically connected to the electrical contact 193b provided on the.
After that, when the shaft 194 is advanced, the insertion hole 192a is inserted.
The built-in treatment tool 196 is projected from the main body catheter 192 through this, and a required treatment can be performed.

[0077]

As described above, according to the present invention, since various built-in treatment tools are housed in the main body catheter, it is not necessary to replace the treatment tools necessary for the treatment each time, and it is possible to accurately and quickly. It is possible to provide a multi-function treatment instrument capable of performing treatment.

[Brief description of drawings]

FIG. 1 is a perspective view of a part of a multifunctional treatment instrument according to an embodiment of the present invention.

FIG. 2 is an explanatory view showing a state in which a gallbladder is resected by the multi-function treatment tool of FIG.

FIG. 3 is an explanatory view showing a procedure for advancing and retracting the built-in treatment instrument to excise the gallbladder, and a portion near the distal end portion of the multifunctional treatment instrument at that time.

FIG. 4 is a cross-sectional view showing a modified example of the grasping forceps of the multifunctional treatment instrument of FIG.

5 is a perspective view of the vicinity of the tip of the grasping forceps of FIG.

6 is an operation explanatory view of a linear actuator that advances and retracts the grasping forceps of FIG.

FIG. 7 is an explanatory diagram showing a configuration of a linear actuator according to a modified example thereof.

FIG. 8 is an explanatory diagram of a linear actuator according to still another modification.

FIG. 9 is an explanatory diagram showing the operation of the gripping arm at the tip of the gripping forceps.

FIG. 10 is an explanatory diagram showing a configuration of a gripping arm of this modified example.

FIG. 11 is an explanatory view showing a gripping arm of still another modified example and its operation.

FIG. 12 is a schematic cross-sectional view of a rotation mechanism that integrally rotates the built-in treatment instrument inside the main body catheter.

FIG. 13 is a schematic explanatory view showing the structure and operation of a multifunctional treatment instrument according to another embodiment.

14 is a schematic cross-sectional view of the multifunctional treatment instrument of FIG. 13 showing the built-in treatment instrument stored in the main body catheter and in a deployed state.

FIG. 15 is an explanatory diagram of a usage state of an embodiment of a multifunctional treatment tool used for crushing gallbladder stones.

16 is an enlarged perspective view showing a distal end portion of the multifunctional treatment instrument of FIG. 15. FIG.

FIG. 17 is an explanatory diagram showing a procedure for crushing a calculus using the multifunctional treatment tool of FIG. 15.

FIG. 18 is a perspective view showing the relationship between the calculus and the gripping arm.

FIG. 19 is a perspective view of a distal end portion of a modified example of the multifunctional treatment instrument that can be used for crushing stones.

FIG. 20 is a perspective view of a distal end portion of still another modified example of this multifunctional treatment instrument.

FIG. 21 is an explanatory view showing the structure of the main body catheter of the multifunctional treatment instrument of FIG. 16.

FIG. 22 is an explanatory diagram showing the configuration and operation of a gripping arm of this multi-function treatment instrument.

FIG. 23 is a schematic explanatory view showing a usage state of an embodiment of a multifunctional treatment instrument used for cell manipulation.

24 is an explanatory view showing a state in which the multifunctional treatment tool of FIG. 23 holds an egg.

FIG. 25 is an explanatory diagram of a modified example of this multifunctional treatment instrument.

FIG. 26 is an explanatory diagram of a pump unit that can be used in the multifunctional treatment tool of FIG. 23.

FIG. 27 is an explanatory diagram showing a schematic cross section of still another modification.

FIG. 28 is an explanatory diagram of a drive mechanism that advances and retracts the syringe unit.

FIG. 29 is an explanatory diagram of an operating mechanism of the syringe unit.

FIG. 30 is a schematic cross-sectional view showing two modified examples of the syringe unit.

FIG. 31 is a schematic sectional view of a syringe unit according to still another modification.

FIG. 32 is a schematic perspective view showing a distal end portion of a multifunctional treatment instrument used for strip biopsy.

FIG. 33 is an explanatory diagram showing an operation procedure by the multi-function treatment instrument of FIG. 32.

FIG. 34 is a schematic explanatory view of a multifunctional treatment instrument provided with a built-in treatment instrument selection mechanism.

FIG. 35 is an explanatory diagram of a multifunctional treatment instrument provided with still another selection mechanism.

[Explanation of symbols]

10, 22, 50, 60, 70, 70a, 70b, 70
c, 90, 100, 120, 170, 180, 190 ...
Multi-function treatment tool, 12, 23, 52, 62, 72, 10
2, 122, 172, 182, 192 ... Main body catheter, 14, 174 ... Grasping forceps, 15, 24, 37, 3
8, 39, 73, 83, 93, 124 ... Gripping arm, 1
6 ... Clip forceps, 17 ... Clip, 18, 19 ... Electric knife, 20, 21, 107, 129, 149, 176 ...
Injection needle, 42, 142, 152 ... Liquid, 53 ... Linear actuator, 54, 56 ... Built-in block, 75 ... Scope, 109 ... Pump unit, 136 ... Actuation unit, 138 ... Drive unit.

[Procedure amendment]

[Submission date] July 3, 1992

[Procedure Amendment 1]

[Document name to be amended] Statement

[Name of item to be corrected] 0070

[Correction method] Change

[Correction content]

The multi-function treatment instrument 180 shown in FIG. 34 has a body or main body catheter 1 as shown in FIG.
A treatment tool holder 184 is rotatably housed in an inner hole 182a formed at the distal end of 82. Treatment tool holder 18
An electrostatic micromotor 188, for example, is installed on the outer peripheral surface of No. 4 and the inner peripheral surface of the inner hole 182a. The electrostatic micromotor 188 allows the treatment instrument holder 184 to freely rotate to a desired position with respect to the main body catheter 182. Can move.

─────────────────────────────────────────────────── ─── Continuation of the front page (51) Int.Cl. ⁵ Identification number Reference number within the agency FI Technical indication location A61B 17/32 330 8718-4C (72) Inventor Akio Nakata 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Yasuhiro Ueda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Inventor Hideyuki Adachi 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Katsunori Sakiyama 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Tsukagoshi 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Hisao Yabe 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical (72) Inventor Yu Konomura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Hideo Ito 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Industry Co., Ltd. (72) Inventor Yoshinao Daimei 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Industry Co., Ltd. (72) In-house Yasuo Mori 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Within Optical Industry Co., Ltd. (72) Inventor Ryusuke Nozawa 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industry Co., Ltd. (72) Inventor Takenao Fujimura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Ori Inpass Optical Co., Ltd. (72) Inventor Takao Okada 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Koichi Tatsumi 2-4-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A multi-function treatment instrument characterized in that a plurality of built-in treatment instruments are arranged at the distal end of a main body catheter to be inserted into the body, and each treatment function unit is operated independently.