JPH0852148A - Endoscope banding device - Google Patents

Abstract

PURPOSE:To provide an endoscope banding device capable of securing a large viewing field by constituting a mechanism to release an O-ring for tying mounted on the tip part of a cylinder with a first slide outer tube member movable in the front and rear direction by wire operation and a second slide outer tube member movable to the front direction by fluid pressure. CONSTITUTION:When this endoscope banding device is to be used, an endoscope 1 is inserted into a fitting part 5 and a wire 13 is drawn to make a first slide outer member 9 in a state located at the most front part. Then, a banding device is inserted into a body cavity such as gullet etc., to recognize the objective affected part 3 of a varix etc., by observing with an endoscope 1. After the tip part of an outer tube member 9 is moved to the front by pushing a wire in to be in contact with the affected part, the affected part tissue is drawn into an inner tube by reducing the pressure by suction from a forceps hole 8 of the endoscope 1. After that, fluid such as air etc., is pressed into a second engaging section 16 via a tube 15 from fluid introduction to move a second slide outer tube member 10 to release an O-ring for banding by pushing out, and banding of the base part of the affected part 3 is performed.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a ligation auxiliary tool applied to ligation of varicose veins of the stomach or esophagus, mucosal resection of stomach or esophagus, polypectomy of the large intestine, and the like.
The present invention relates to an endoscopic ligation tool that allows safe and reliable treatment by a simple operation.

[0002]

2. Description of the Related Art As a method for treating gastric and esophageal varices associated with liver cirrhosis, a sclerosing agent having endothelial cytotoxicity is injected into the varicose vein or outside the varicose vein to locally stagnate and form a thrombus. Until now, the endoscopic sclerosing aneurysm method, which devastates varicose veins by blocking blood circulation, has been the mainstream. However, intravenous administration of drugs that have adverse effects on the living body, combined with the complex hemodynamics of portal hypertension, causes various complications such as pulmonary embolism, lung failure, and renal damage. Cause it to happen. Therefore, the amount of the curing agent used at one time is limited, and since the treatment is performed in consideration of the recovery of the patient, the treatment time becomes long.

As an alternative treatment method for stomach and esophageal varices, esophageal varices ligation (hereinafter referred to as "EVL") has recently been performed.
Has come to be used. As shown in FIG. 4, the EVL is a ligating O-ring 4 that sucks a varicose vein 3 into a cylinder portion 2 attached to a distal end portion of an endoscope 1 and is attached in advance around the distal end of the cylinder portion. Is a surgical treatment means for removing the wire by a wire operation and hooking it on the root portion of the varicose vein 3 which has been sucked to form a polyp, and ligating the varicose vein by the tightening force of the ligating O-ring 4 to devastate it. The ligated varicose veins are destroyed after about one week and spontaneously fall off.

Conventionally, as a ligating tool used for this EVL, a ligating O-ring 4 is attached to the inside of a cylinder part 2 fixed to a mounting part 5 into which a tip part of an endoscope 1 is fitted as shown in FIG. A structure is used in which the mounted slide cylinder 6 is slidably inserted into the surface, and the slide cylinder 6 is fixed to a trip wire 7 passing through a forceps hole of the endoscope 1. In this structure, when the trip wire 7 is pulled toward you, the slide cylinder 6 retracts, and the tip end of the cylinder portion 2 pushes off the ligating O-ring 4 to separate it.

The EVL using the above-mentioned endoscopic ligation tool is
Unlike conventional sclerotherapy, there is no need to use a large amount of sclerosing agent, it is a highly safe treatment method with few side effects on the patient, and it is a simple operation without requiring a particularly difficult technique for treatment. The number of facilities applying this therapy is rapidly increasing because of the safe ligation procedure.

However, some problems have been pointed out in EVL. First, there is a problem that the field of view of the endoscope is significantly reduced when the ligation tool is attached to the endoscope. Especially when treating varicose veins that have already bleeded, narrowing the field of view of the endoscope is a serious drawback in therapy,
The risk of difficulty in identifying the target bleeding site increases. Secondly, in the conventional ligation tool, since the mechanism for removing the O-ring is performed by operating the trip wire through the forceps hole of the endoscope, one forceps hole of the endoscope becomes unusable. Therefore, it becomes impossible to perform an operation such as sucking bleeding. In addition, at a specific site of gastric varices, the endoscope may be used by strongly inverting it. In such a case, even if the trip wire is pulled, the force is not transmitted well to the distal end and the ligating O-ring falls. There are cases where it cannot be done.

On the other hand, at present, the endoscope is generally used not only for the EVL but also for the treatment of removing polyps such as the mucous membrane of the stomach, esophagus, and large intestine. In these procedures as well, the mucosa and polyps are excised using a high-frequency snare under the observation of an endoscope, but there is a risk of bleeding during the excision. For this reason, studies are being made to apply and process the ligation tool used for EVL. For example, in gastric mucosal resection, a ligation tool is brought into contact with a target site in the same manner as EVL, and after suction, the root of the affected area is ligated by an O-ring and then excised with a high-frequency snare.

However, even in such a case, the drawbacks of the EVL described above, such as the narrow field of view of the endoscope, the use of forceps holes, and the difficulty in normal operation when the endoscope is strongly inverted, remain unchanged. The rest is a major improvement issue.

[0009]

DISCLOSURE OF THE INVENTION The present invention has been made as a result of many structural improvements to solve the above-mentioned problems of the endoscope ligation tool having the conventional structure, and its purpose is to: An endoscope ligation tool that can secure a wide field of view of the endoscope, has a mechanism that operates normally even when the endoscope is strongly inverted, and can always perform a safe and reliable ligation procedure with a simple operation. To provide.

[0010]

An endoscope ligation tool according to the present invention for achieving the above object comprises a cylinder portion fixed to a front surface of a mounting portion into which a distal end portion of an endoscope is fitted,
An endoscope ligation tool of a mechanism, comprising a slide cylinder that slides in a plane with the cylinder part, wherein a ligating O-ring, which is ring-attached to the tip of the cylinder, is released through a push-out operation by forward movement of the slide cylinder. A first connecting at least one operation tube extending from the mounting portion to the outside
And a locking rib, which is provided around the outer peripheral surface of the cylinder portion so as to be movable back and forth by a wire operation, and which fixes a wire for communicating the operation tube to the rear end, A first slide outer cylinder member having a second locking section having a closed space structure in which a fluid introduction tube is connected to a rear portion of the ligation O-ring ring attachment portion and the ligation O-ring ring attachment portion. And is provided around the outer peripheral surface of the first slide outer cylinder member so as to be movable forward by an operation of introducing a fluid into the second locking section,
A characteristic feature of the present invention is that the fluid stopper is located inside the second locking section, and the pressing tip for releasing the ligating O-ring is a ring-shaped second slide outer cylinder member protruding to the front. To do.

[0011]

According to the endoscopic ligation tool of the present invention, a mechanism for disengaging the ligating O-ring is provided around the outer peripheral surface of the cylinder portion, and a first slide outer cylinder member which moves back and forth by a wire operation, Around the outer peripheral surface of the first slide outer cylinder member, the second slide outer cylinder member is configured to move forward through a two-step operation by a fluid pressure. Of these, the first slide outer cylinder member and the second slide outer cylinder member are both provided around the outer surface of the cylinder portion fixed to the front surface of the mounting portion into which the endoscope is fitted, and therefore, the front surface of the endoscope. Is open without any obstacles and does not narrow the field of view.

The wire for moving the first slide outer cylinder member is designed to be operated by the operator through the operation tube extending from the mounting portion to the outside, and the wire for moving the second slide outer cylinder member is also moved. The fluid to be caused to flow into the second locking section through the fluid introduction tube extending along the peripheral surface of the cylinder portion, so that no member obstructing the operation is inserted into the forceps hole of the endoscope. Not not. Therefore, there is no possibility that suction or the like cannot be performed when bleeding occurs.

Further, a forward movement of the first slide outer cylinder member by a wire operation forms a space for sucking and accommodating an affected area such as a varicose vein, and the ligating O-ring is separated from the second slide outer cylinder member by utilizing fluid pressure. Since it is performed by moving the wire forward, accurate treatment can be performed with a simple procedure compared to the conventional structure in which only the wire is operated, and the smoothness of operation can be impaired even when performing treatment while strongly reversing the endoscope. Disappear.

Together with the above mechanism, it is possible to always perform a safe and accurate ligation procedure by a smooth operation while ensuring a wide field of view of the endoscope.

[0015]

EXAMPLES The present invention will be described in detail below based on the examples illustrated in FIGS. In these figures, the same members as those in FIGS. 4 to 5 are designated by the same reference numerals.

FIG. 1 is a cross-sectional view showing an endoscope ligation tool according to the present invention with an endoscope fitted therein, and FIG. 2 shows a state in which a first slide outer cylinder member is moved forward by a wire operation. FIG. In these figures, 1 is an endoscope having a plurality of forceps holes 8 penetratingly installed therein, 5 is a mounting portion for fitting the endoscope 1, 2 is a cylinder portion fixed to the front surface of the mounting portion 5, 9 Reference numeral 10 denotes a first slide outer peripheral member that is provided on the outer peripheral surface of the cylinder portion 2 so as to be movable forward by a wire. Reference numeral 10 denotes a first slide outer peripheral member that is provided on the outer peripheral surface of the first slide outer peripheral member 9 so as to be movable forward by fluid pressure operation. It is a two-slide outer peripheral member.

The mounting portion 5 is a member into which the distal end of the endoscope 1 that is easily damaged is inserted, and since endoscopes having different calibers may be used, the mounting portion 5 is made of a material that is flexible and does not easily fall off. . For example, a rubber-based material such as a silicone rubber-based resin and an elastic resin material such as a soft polyvinyl chloride-based resin or a soft polyurethane-based resin are preferable, but not limited thereto. When it is made of silicone rubber resin, it is formed into a predetermined shape mainly by compression molding, and when it is made of thermoplastic resin, it is formed into a predetermined shape by injection molding.

The cylinder portion 2 is provided with a first locking section 12 which is connected to a rear portion of the operation tube 11 which extends through the inside of the mounting portion 5 to the outside. The first locking section 12 serves as a portion for controlling the forward movement range of the first slide outer cylinder member 9. The material of the cylinder part 2 is
It is preferable to use a hard resin that has good adhesiveness with the mounting portion 5 and excellent slidability with the first slide outer cylinder member 9. Further, the operation tube 11 is not limited to one, and a plurality of tubes can be installed. The material is endoscope 1
Since it is used along with, it is suitable to use polyvinyl chloride resin, etc., which has appropriate flexibility and a thin and thin tube with appropriate elasticity that does not easily collapse, and can be formed by an extrusion molding method. it can.

1 and 2, the first locking section 12 has a cylindrical shape. However, if the first locking section 12 is formed in a cylindrical shape, resistance increases when the first slide outer cylinder member 9 moves forward, resulting in smoothness. There is a risk of movement being hindered. Therefore, the first locking section 12 may be designed not to have a cylindrical shape but to have a rectangular cutout as shown in FIG. 3 to reduce the frictional resistance to the operation of the first slide outer cylinder member 9. it can.

The first slide outer cylinder member 9 has a locking rib 14 to which a wire 13 for communicating the operation tube 11 is fixed at the rear portion thereof, an attachment portion of an O-ring 4 for ligation at the most distal end, and a ligation O. A second locking section 16 having a fluid inflow tube 15 connected thereto is provided at a rear position of the ring 4 at the ring-attached portion, and the wire 13 is pushed to move forward by sliding the outer surface of the cylinder section 2. Then, it becomes a member that forms a space for sucking and storing the affected area on the front surface of the endoscope 1.
The second locking section 16 is designed to have a closed space structure in the state where the second slide outer cylinder member 10 is housed. The stroke distance by which the first slide outer cylinder member 9 moves forward is determined by the first locking section 1 provided in the cylinder portion 2.
The range is 2 and when the wire 13 is pushed in, the first locking section 12 and the locking rib 14 are in contact with each other as shown in FIG.

Since the first slide outer cylinder member 9 is projected from the tip of the endoscope 1 during use, it is preferably made of a transparent resin material which easily secures a visual field. Examples of suitable transparent resin materials include, but are not limited to, polycarbonate resins, ABS resins, hard polyvinyl chloride resins, nylon resins, and the like. The molding method may be either injection molding or cutting, but injection molding is preferable in terms of dimensional accuracy and cost.

The wire 13 needs to have sufficient rigidity to push out the first slide outer cylinder member 9 even when the endoscope 1 is inverted, and the material thereof is a stainless steel wire as a single wire or a mini rope. Etc. are preferably used. The number of wires is not particularly limited, but in the case of one wire, the pressing force at the time of reversing the endoscope may be insufficient to operate normally, while on the other hand, if the number of wires is increased, the pressing force increases, A large number of wires exist outside the endoscope, which may be entangled with the endoscope and impair the operability. Therefore, 2 to 3 are suitable. Further, when using a plurality of wires, it is effective to combine them into one operation tube at an intermediate stage and design it so that it can be operated by one hand operation.

The material of the O-ring 4 needs to be selected from those having a property of sufficiently tightening the affected area when it is detached. Examples of preferable materials include synthetic rubbers such as natural rubber, isoprene rubber, and neoprene rubber.

The second slide outer cylinder member 10 is a fluid stopper 1.
7 is the second locking section 1 in the first slide outer cylinder member 9
6 is a ring-shaped member that is located inside 6 and has a pressing tip portion that releases the ligation O-ring 4 from the second locking section 16 to the front surface. The second slide outer cylinder member 10 is housed in the second locking section 16 of the closed space structure formed in the first slide outer cylinder member 9 as described above, and through the fluid introducing tube 15. The inflowing fluid is the fluid stopper 1.
7 is pressed to move forward, and the ligating O-ring 4 is detached by the pressing tip. Therefore, the second locking section 16
In order to enhance the airtightness and to smoothly operate the second slide outer cylinder member 10, it is also effective to enclose a ligating O-ring.

The second slide outer cylinder member 10 is preferably made of a transparent resin material like the first slide outer cylinder member 9. For example, polycarbonate resin, ABS resin, hard polyvinyl chloride resin, nylon. It can be formed of a system resin or the like. It is also possible to apply a lubricant such as oil to the sliding surfaces of the first slide outer cylinder member 9 and the second slide outer cylinder member 10.

The standard dimensions of each member constituting the endoscopic ligation tool according to the present invention are as follows. The outer diameter of the tip of the endoscope 1 used for EVL is usually about 10 mm. Therefore, the inner diameters of the mounting portion 5 and the cylinder 2 are set to be slightly larger than 10 mm in which the main body of the endoscope 1 is securely fitted. The ligation tool needs to pass through the pharynx when ligating the affected part of the esophagus, and generally, the overtube is left in the pharynx in advance and inserted in order to facilitate the passage. For this reason, the maximum outer diameter of the ligation tool is restricted to the inner diameter of the overtube, and usually 14 to 15
mm.

The endoscope 1 is mounted at a position where it does not obstruct the front view when the first slide outer cylinder member 9 is retracted, but considering the view angle of a general endoscope, the endoscope 1 has a length of about 5 mm or less. In that case, there is no problem even if the tip of the tool projects beyond the tip of the endoscope. Although the stroke length of the first slide outer cylinder member 9 differs depending on the relationship between the required volume when sucking the affected tissue and the mounting length when the endoscope is set, There is no problem as long as the tip surface when protruding to the end is about 10 to 15 mm longer than the end surface of the endoscope 1.

The endoscopic ligation tool according to the present invention is used as follows. First, the endoscope 1 is inserted into the mounting portion 5 and fitted so that the tip thereof is located near the tip side of the cylinder portion 2. At this time, pull the wire 13 to
The outer slide cylinder member 9 is brought to the frontmost position.
In this state, the visual field of the endoscope 1 is maintained well. Then, the ligation tool is inserted into a body cavity such as the esophagus, and the target affected area is confirmed while observing the affected area such as a varicose vein with the endoscope 1,
The wire 13 is pushed in to move the first slide outer cylinder member 9 forward. The distal end portion of the first slide outer cylinder member 9 is brought into contact with the affected area, suctioned and decompressed from the forceps hole 8 of the endoscope 1, and the affected tissue is sufficiently drawn into the inner cylinder. In this state, when a fluid such as air or water is press-fitted into the second locking section 16 via the fluid introducing tube 15, the second slide outer cylindrical member 10
Moves forward and its pressing tip pushes out the ligating O-ring 4 to separate it, and completely ligates the root of the affected tissue.
After ligating in this way, the ligating tool is pulled out of the body to complete the operation.

[0029]

As described above, according to the endoscopic ligation tool of the present invention, it is possible to secure a wide endoscope visual field without causing a visual field obstruction in the observation of the endoscope unlike the conventional structure. It is possible to always perform the ligation procedure safely and accurately by performing various operations. In addition, a precise procedure can be performed by a simple procedure, and the smoothness of the operation is not impaired even when the procedure is performed while strongly reversing the endoscope. Therefore, it becomes easy to treat a minute affected area, which has been difficult with the conventional tools, and all can be effectively used without closing the forceps hole of the endoscope. Therefore, operations such as cleaning and suction of the digestive tract can be performed efficiently. The practical effect of being able to do is brought.

[Brief description of drawings]

FIG. 1 is a sectional view showing an embodiment of an endoscopic ligation tool according to the present invention.

FIG. 2 is a cross-sectional view showing the endoscope ligation tool in a state where some operations are added to FIG.

FIG. 3 is a perspective explanatory view showing another embodiment of the endoscopic ligation tool according to the present invention.

FIG. 4 is a perspective explanatory view showing a usage state of the endoscope ligation tool.

FIG. 5 is a cross-sectional view showing an endoscope ligation tool having a conventional structure.

[Explanation of symbols]

 1 endoscope 2 cylinder part 3 varicose vein 4 ligation O-ring 5 attachment part 6 slide cylinder 7 trip wire 8 forceps hole 9 first slide outer cylinder member 10 second slide outer cylinder member 11 operation tube 12 first formation Compartment 13 Wire 14 Locking rib 15 Fluid introduction tube 16 Second locking compartment 17 Fluid stop

Claims (1)

[Claims] 1. A cylinder portion fixed to the front surface of a mounting portion into which a distal end portion of an endoscope is fitted, and a slide cylinder that slides on the cylinder portion in a plane. A push-out operation by forward movement of the slide cylinder is performed. In an endoscope ligation tool having a mechanism for releasing a ligation O-ring that is annularly attached to a cylinder front end via a first locking section, which is connected to at least one operation tube extending from a mounting portion to the outside at a rear portion thereof. Cylinder portion having, and a locking rib that is provided around the outer peripheral surface of the cylinder portion so as to be movable back and forth by a wire operation, and has a rear portion fixed with a wire that communicates the operation tube,
A first slide having a ligation O-ring ring-attached portion at the most distal end and a second locking section having a closed space structure in which a fluid introduction tube is connected to the rear portion of the ligation O-ring ring-attached portion An outer cylinder member and an outer peripheral surface of the first slide outer cylinder member are circumferentially provided so as to be movable forward by an operation of introducing a fluid into the second locking section, and a fluid stopper is provided in the second locking section. An endoscopic ligation tool, characterized in that it comprises a ring-shaped second slide outer cylinder member having a pressing tip portion located inside thereof and for releasing the ligation O-ring, and protruding toward the front.