JPH0616785B2 - Exclusion measure - Google Patents

Description

TECHNICAL FIELD The present invention relates to an exclusion treatment instrument capable of pulling aside tissues or organs that interfere with treatment of a target site.

[Problems to be Solved by Conventional Techniques and Inventions] In recent years, by inserting an elongated insertion portion, it is possible to observe the inside of a body cavity without making an incision from the body surface or to perform a medical treatment with a treatment tool. Endoscopes have become widely used.

The endoscope includes a flexible endoscope which has a flexible insertion portion and is inserted from the oral cavity and the like, and a rigid endoscope which has a rigid insertion portion and is guided by a trocar or the like toward an observation target site in a body cavity. There is a mirror.

By the way, a rigid endoscope (laparoscope), which is mainly used for observing the abdomen, is inserted into the body cavity through a trocar, and the body cavity is observable transendoscopically while observing the body cavity through another trocar. It is widely practiced to perform treatment using various treatment tools inserted therein, but when performing treatment using the treatment tool, the target site to be treated is disturbed by surrounding tissues or organs. In some cases, the treatment tool cannot be introduced to the target site, or appropriate treatment cannot be performed. In such a case, conventionally, another trocar is punctured in the abdomen, and the treatment is performed while pulling an obstructing tissue or organ aside by another treatment tool introduced into the body cavity through the trocar.

FIG. 8 is an explanatory diagram showing a conventional example of treatment under observation with an endoscope.

In this figure, an operator 1 observes the inside of the body cavity 3 with an endoscope 4 inserted into the body cavity 3 through an endoscopic trocar 2 that has been punctured into the abdomen 11 of the patient, and the procedure in which the abdomen 11 is punctured The treatment is performed using the treatment instrument 6 inserted into the body cavity 3 through the instrument trocar 5. Next to the operator 1, the assistant 7 observes the inside of the body cavity 3 with the lecture scope 8 connected to the endoscope 4, while passing through the trocar 9 for the exclusion treatment instrument punctured in the abdomen 11 to the inside of the body cavity 3. The removal treatment instrument 10 inserted in the device removes a tissue or an organ (not shown) that prevents the treatment instrument 6 from being introduced into the target site or interferes with the treatment.

Thus, conventionally, in order to exclude disturbing tissues and organs, in addition to the trocar 2 for the endoscope and the trocar 5 for the treatment instrument, the trocar 9 for the exclusion treatment instrument must be punctured into the abdomen 11 or the like of the patient. Therefore, there is a problem in that the abdomen 11 is damaged much. Further, since the operator alone cannot perform the treatment with the treatment tool 6 while observing the endoscope 4, the disturbing treatment tool 10 can also remove the disturbing tissue or organ. Is required, and when two operators separately operate the treatment instrument 6 and the exclusion treatment instrument 10, it is difficult to perform an appropriate treatment, and the efficiency and workability of the treatment are poor. .

[Object of the Invention] The present invention has been made in view of the above circumstances, and it is possible to eliminate surrounding tissues or organs that hinder the treatment of a target site, reduce damage to a patient, and improve the efficiency of the treatment. It is an object of the present invention to provide an exclusion treatment tool that can improve workability.

[Means and Action for Solving Problems] An exclusion treatment instrument according to the present invention includes a hollow outer tube, a movable member axially movably inserted into the outer tube, and having a treatment instrument passage therein. An operating means is provided on the rear end side of the moving member, and is provided on the front end side of the moving member, and an operating means for moving and operating the moving member. The moving member allows the moving member to project and retract from the front end of the outer tube. At the same time, the excluding member is provided with a characteristic that the tip side of the outer tube expands when it projects from the tip.

In the expulsion treatment instrument according to the present invention, the excluding member is caused to protrude from the extremity of the outer tube and the extremity side of the excluding member is expanded by moving the moving member in the distal direction with respect to the outer tube by the operating means. . Then, it is possible to perform the treatment with the treatment instrument inserted into the treatment instrument passage inside the moving member while eliminating the surrounding tissues or organs which obstruct the treatment by the expanded exclusion member. ing.

[Embodiment] FIGS. 1 to 3 relate to an embodiment of the present invention. FIG. 1 is a sectional view of an exclusion treatment tool, and FIG. 2 is a sectional view taken along the line AA ′ of FIG. The figure is a sectional view of the distal end side of the exclusion treatment tool in the use state.

In the exclusion treatment instrument 21 of the present embodiment, a hollow inner tube 23 as a moving member is slidably inserted into an elongated hollow outer tube 22 having an outer diameter dimension that can be inserted into a trocar (not shown). . At the rear end of the outer pipe 22, an operation portion main body 24 having a hollow portion through which the inner pipe 23 can be inserted is continuously provided. A finger hook 24a is formed at the front end of the operation section body 24. Further, on the outer peripheral portion on the rear end side of the inner pipe 23, for example, a thick-walled cylindrical operation member 25 that can be hooked with a finger.
Is fixed. A spring 26 such as a coil spring for biasing the operating member 25 rearward with respect to the operating portion main body 24 is interposed between the front end of the operating member 25 and the rear end of the operating portion main body 24. The operation portion main body 24, the operation member 25, and the spring 26 constitute operation means for moving and operating the inner pipe 23 in the axial direction.

Further, a ratchet groove 27 is formed in the outer peripheral portion of the inner pipe 23 in the axial direction from the position where the operating member 25 is fixedly installed to the middle of the tip side. On the other hand, the operation portion main body 24 is partially notched on the rear end side, and the ratchet pawl 2 that can be engaged with the ratchet groove 27 at the notched portion.
8 are provided. The ratchet pawl 28 is rotatably supported on the operation portion main body 24 by a rotation shaft 29.
Further, the ratchet pawl 28 is biased in the clockwise direction by the leaf spring 30 fixed to the operation portion main body 24, and the clockwise rotation is restricted by the operation portion main body 24. Engages with the ratchet groove 27 to regulate the movement of the inner pipe 23 so that the inner pipe 23 can be fixed to the outer pipe 22 at any position.

As shown in FIG. 2, for example, two excluding members 31, 31, which are made of an elastic material in the shape of a round rod having a spherical distal end, are fixed to the distal end of the inner tube 23. The expulsion member 31 is moved by the movement of the inner pipe 23 to cause the outer pipe 22 to move.
In the state where it is sunk from the tip of the
When the outer tube 22 is straight along the inner wall of the outer tube 22 and protrudes from the tip of the outer tube 22, the tip side of the outer tube 22 is urged to expand as shown in FIG. The amount of expansion of the excluding member 31 can be arbitrarily set by arbitrarily setting the amount of protrusion of the excluding member 31 from the tip of the outer tube 22.

Further, inside the inner tube 23, a treatment instrument passage 32 is formed in the hollow portion of the inner tube 23. A rubber cap 34 is provided at the rear end of the inner tube 23 to have a treatment instrument insertion opening 34a and to maintain airtightness when the treatment instrument 35 is inserted into the treatment instrument passage 32.

Next, the operation of the embodiment having the above configuration will be described with reference to FIG.

For example, when performing treatment with a treatment instrument under the observation of an endoscope (not shown) inserted into a body cavity through a trocar (not shown), the treatment instrument passage 32 in the inner tube 23 of the exclusion treatment instrument 21 of the present embodiment is treated. The treatment instrument 35 is inserted, and the exclusion treatment instrument 21 is inserted into the body cavity through another trocar (not shown) while the exclusion member 31 is immersed in the outer tube 22. Then, the treatment tool 35 is projected from the distal ends of the inner tube 23 and the outer tube 22 to treat the target site 36. When performing this procedure, the tissue 37 around the target site 36 is removed by the treatment tool 3
When the movement of 5 is obstructed, the operation member 25 is moved to the distal end side with respect to the operation portion main body 24 against the spring 26 to move the inner pipe 23 to the distal end side with respect to the outer pipe 22. To move. As a result, the excluding member 31 projects from the tip of the outer tube 22 and the tip side thereof is expanded. By expanding the exclusion member 31, the target portion 36
The surrounding tissue 37 which hinders the treatment of 1 can be pulled aside, and the treatment with the treatment tool 35 can be easily performed.

In this embodiment, the inner pipe 23 can be fixed to the outer pipe 22 at an arbitrary position by the ratchet mechanism including the ratchet groove 27 and the ratchet pawl 28, and the excluding member 31 can be fixed from the tip of the outer pipe 22. By arbitrarily setting the protrusion amount, the expansion amount of the excluding member 31 can be arbitrarily set according to the tissue to be excluded.

When the exclusion member 31 is pulled into the outer tube 22 or when the expansion amount of the exclusion member 31 is reduced, the ratchet pawl 28 is rotated counterclockwise against the biasing force of the leaf spring 30. By making this ratchet claw 28
And the ratchet groove 27 are disengaged. Then, the inner tube 23 moves rearward by the biasing force of the spring 26, and the excluding member 31 is drawn into the outer tube 22.

As described above, according to the present embodiment, since the treatment instrument 35 can be inserted into the treatment instrument passage 32 in the inner tube 23, a tissue or an organ that interferes with the treatment can be eliminated through one trocar, Various treatments can be performed on the target site, and damage to the patient can be reduced. In addition, the removal of the tissue or organ that hinders the treatment and the treatment with the treatment tool can be performed by one person under the observation of the endoscope.
The treatment efficiency and workability are improved.

In this embodiment, the inner pipe 23 is fixed to the outer pipe 22 by the ratchet mechanism including the ratchet groove 27 and the ratchet pawl 28. However, as shown in FIG.
Fixing screw 3 penetrating from the outer periphery of the operation part body 24 to the hollow part
Alternatively, the inner tube 23 may be fixed by means of 8.

The moving member is not limited to the inner pipe 23, and may be, for example, a rod-shaped member that can move along the inner wall of the outer pipe 22.

Further, the shape of the excluding member 31 is not limited to the round bar shape, and may be, for example, a plate shape or a cylindrical shape having a plurality of slits on the tip side, and the number of excluding members 31 is not limited to two. It may be one, or three or more.

Further, the rubber cap 34 that keeps airtightness when the treatment instrument is inserted
In addition, if a cock that opens and closes the treatment instrument passage 32 is provided, air tightness is further secured.

Further, the spring 26 is not limited to the coil spring, and may be a leaf spring or the like. The spring for urging the ratchet pawl 28 in the clockwise direction is not limited to the leaf spring 30. For example, the spring 26 may be twisted around the rotating shaft 29. A coil spring may be provided.

As an example of various treatment tools used in combination with the exclusion treatment tool 21 according to the present invention, there is a ligation treatment tool as shown in FIGS. 5 to 7.

FIG. 5 is a sectional view of the ligature holding device, FIG. 6 is a right side view of FIG. 5, and FIG. 7 is a front view of the ligature.

The ligation treatment tool is composed of a ligature holding tool 42 and a ligature 43.

The ligature holding device 42 includes a hollow insertion tube 45 having a ligature passage 44 inside thereof, and a distal end side of the insertion pipe 45 having a tip-side insertion hole 46 communicating with the ligature passage 44. The member 47 is fixed. This tip member 4
The distal end surface of 7 is formed in a spherical shape, and the inner diameter of the distal end side insertion hole 46 is smaller than the inner diameter of the ligature passage 44.

On the other hand, the ligature passage 4 is provided on the rear end side of the insertion tube 45.
A front main body 48 having a hollow portion communicating with 4 is continuously provided. A luer lock-shaped connecting portion 48a is formed at a rear end portion of the front body 48, and the luer lock-shaped connecting portion 48a is formed.
A rear body 49 is detachably connected to the rear body 49. After this, on the tip side of the main body 49, the luer lock-shaped connecting portion 48a is formed.
A groove portion 50 having an annular cross section is inserted in the axial direction. A female screw 50a is threaded on the outer surface of the groove 50, and the rear body 49 and the front body 48 are connected by screwing the female screw 50a with the luer lock-shaped connecting portion 48a. Also, after this, in the main body 49,
A proximal insertion hole 51 communicating with the ligature passage 44 and a slit 52 are provided in order from the distal end side, and a ligature 4 is provided below the central portion of the slit 52 as shown in FIG.
A guide groove 52a for positioning the No. 3 is provided. Further, the rear body 49 is provided with a fixing screw 53 penetrating from the outer peripheral portion to the slit 52, and the ligature 43 is formed by the end surface of the fixing screw 53 and the end surface of the slit 52.
It can be clamped and fixed.

As shown in FIG. 7, the ligature 43 is made of one thread and is tied so as to form a ring 54 on the tip side.
The knot 55 is a distal end side insertion hole 46 of the ligature holding device 42.
It is formed in a size that does not pass through. And the knot 5
By pulling the hand side portion 56 with 5 fixed, the size of the ring 54 is reduced.

To perform a ligation procedure using this ligation treatment tool, first,
The proximal side portion 56 of the ligature 43 is inserted into the ligature passage 44 through the distal end side insertion hole 46 of the ligature holder 42, and further,
The rear body 4 is passed through the insertion hole 51 on the near side and the slit 52.
Pull out from the rear end of 9. Then, the loop 5 of the ligature 43
In the state where 4 is projected from the tip of the tip member 47, the proximal side portion 56 of the ligature 43 is positioned by the guide groove 52a and fixed by the fixing screw 53.

In this state, for example, the insertion tube 45 is inserted into the treatment instrument passage 32 of the exclusion treatment instrument 21 according to the present invention, and the ligature 4 is inserted into the body cavity.
Introduce 3. Then, the loop 54 of the ligature 43 is put on a portion (not shown) that requires ligation for the purpose of hemostasis or the like.
Next, by rotating the rear body 49 with respect to the front body 48, the rear body 49 is removed from the front body 48,
After that, the main body 49 is pulled, and then the ligature 43 fixed to the main body 49 is pulled by the screw 53. Then, since the knot 55 of the ligature 43 cannot pass through the distal end side insertion hole 46, the knot 55 is locked by the distal end member 47, the ring 54 becomes gradually smaller, and a region (not shown) requiring ligation is ligated. be able to.

Needless to say, the ligation treatment tool can be directly inserted into the body cavity through a trocar or the like.

Further, the exclusion treatment instrument 21 according to the present invention is not limited to the above-mentioned ligation treatment instrument, and various treatment instruments such as forceps, a hemostatic tool, and a cutting instrument are used in combination.

[Effects of the Invention] As described above, according to the present invention, an excluding member having a characteristic of expanding the tip side when protruding from the tip of the outer tube can be projected and retracted from the tip of the outer tube. Because I did
It is possible to eliminate the surrounding tissues or organs that hinder the treatment of the target site, and since the treatment tool passage is provided inside the moving member, eliminate the surrounding tissues or organs that hinder the treatment and treat the target site. It can be performed through a single trocar, which has the effect of reducing damage to the patient.

In addition, it is possible to eliminate the tissue or organ that hinders the treatment and perform the treatment with the treatment tool by one person under the observation of the endoscope, and it is possible to improve the efficiency and workability of the treatment. There is.

[Brief description of drawings]

1 to 3 relate to an embodiment of the present invention. FIG. 1 is a cross-sectional view of an exclusion treatment instrument, FIG. 2 is a cross-sectional view taken along the line AA 'of FIG. 1, and FIG. FIG. 4 is a sectional view of the distal end side of the exclusion treatment instrument in FIG. 4, FIG. 4 is a sectional view of the periphery of the operating portion body showing a modified example of the embodiment, and FIGS. 5 to 7 are used in combination with the exclusion treatment instrument of the present invention. FIG. 5 is a cross-sectional view of a ligature holding device, and FIG. 6 is a right side view of FIG.
FIG. 7 is a front view of a ligature, and FIG. 8 is an explanatory view showing a conventional example of treatment under observation with an endoscope. 21 ... Elimination treatment tool, 22 ... Outer tube 23 ... Inner tube, 24 ... Operation part body 25 ... Operation member, 27 ... Ratchet groove 28 ... Ratchet claw, 31 ... Exclusion member 32 ... Treatment Ingredient passage

Claims (1)

[Claims] 1. A hollow outer tube, a moving member axially movably inserted into the outer tube and having a treatment instrument passage therein, and a moving member provided on the rear end side of the moving member. An operating means for moving and a distal end side of the moving member are provided so that the moving member allows the movable member to project and retract from the distal end of the outer tube, and the distal end side expands when projecting from the distal end of the outer tube. An exclusion treatment tool comprising: an exclusion member having a characteristic of opening.