JPS6138569Y2 - - Google Patents

Description

[Detailed description of the invention] [Technical field of the invention] The invention involves inserting a detachment device between the extraprostatic glands and the enlarged intraprostatic glands under direct observation through a scope, and detaching the internal glands from the external glands. This relates to a urinary endoscope that can completely remove the internal glands, and has a particularly simple and inexpensive structure that can be used in combination with various types of general urinary endoscope sheaths such as cystourethroscopes and resectoscopes. This invention relates to a prostate ablation device for a urinary endoscope that has been improved to have as much versatility as possible and to be durable enough to withstand forced use.

[Technical background of the invention and its problems] In recent years, endoscopes have been widely used for observing, diagnosing, and treating affected areas by inserting an insertion section into a body cavity. This endoscope includes a resectoscope that is inserted into the bladder through the urethra and is configured to perform treatments such as prostate resection using electrodes to which high-frequency current is applied.

In general, a resect scope consists of a scope, an electrode, a resect sheath into which the scope and electrode are inserted, a grip protruding from the rear and lower part of the resect sheath, and a movable member that fixes the rear end of the electrode and is provided with a finger rest. The finger of one hand is inserted into the grip of the resect sheath and the finger hook of the movable member, and the grip movable member is moved to bring the two closer together, and the electrode is moved forward and backward within the resect sheath.

However, the conventional resectoscope configured in this way removes the intraprostatic gland by applying electricity to the protruding electrode extending from the tip of the resect sheath, and it is difficult for the human body to completely remove the enlarged intraprostatic gland. It is extremely difficult to perform this procedure as it poses a danger to the body, and the drawback is that some of the internal glands remain and the prostate tissue becomes enlarged again.

For this reason, a resectoscope has been proposed in which a dissecting element that can move forward and backward is disposed within the scope to detach and remove the enlarged internal gland of the prostate from the external gland. This resectoscope is constructed as shown in FIG. Reference numeral 1 denotes a resect sheath to be inserted into the urethra, and a water intake port 3 communicating with the inside of the sheath 1 is formed in a grip 2 formed at the base of the sheath 1. Code 4 is the scope,
This scope 4 has a light source connection part 5, and is further attached with an insertion part 6 that is inserted into the sheath 1 almost to the distal end, so that the front of the distal end of the sheath 1 can be directly viewed from the eyepiece part 4a. . Reference numeral 7 denotes a moving body, which is equipped with a finger rest 8 and has an eyepiece 4a and a sheath 1.
It is supported by a guide 9 provided between the base part and is movable back and forth, and the eyepiece part 4a is always located on the hand side by a spring 10 with one end attached to the movable body 7 and the other end attached to the sheath 1 base part side. It is urged to retreat to the side. A fixing member 12 is attached to the movable body 7 at the base of the support shaft 11a of the peeling element 11 inserted into the sheath 1.
The separator, electrodes, etc. can be removably fixed at the sheath 1 by moving the movable body 7 forward. However, the reference numeral 7a is a scope guide tube, and the scope insertion portion 6 is inserted into this guide tube 7a.

2 to 3 show an example of the distal end portion of the sheath 1 shown in FIG. 1, and the peeling element 11 is formed into a generally gutter shape that can slide on the inner wall surface of the lower half of the distal end bulging portion 1a of the sheath 1. Moreover, its tip is shaped like a tapered tongue. A rod-shaped member is attached to the support shaft 11a of the peeler 11, and the proximal end of this member is detachably attached to the movable body 7 using the fixing member 12, and as the movable body 7 moves forward, the rod-like member is attached. It is constructed so that it can protrude forward from the front.

However, the separator 11 of the resect scope configured as described above is used in combination with the resect scope, and it lacks versatility and has a complicated structure, making it expensive and easily damaged. . In addition, in the structure shown in FIGS. 2 and 3, the stripper 11 is formed into a generally gutter-like shape so that it can slide on the inner wall surface of the lower half of the distal end bulge 1a of the sheath 1, and its distal end is tapered. The base of the peeler is connected to the movable body 7 on the proximal side through a rod-like member.
Because the stripper 11 is attached to the rod-shaped member when trying to detach the affected tissue, the stripper 11 may be deformed by the rod-shaped member, and as a result, unreasonable force is applied to the scope 4, especially the scope insertion portion 6. There was a problem with damaging an expensive scope.

[Purpose of the invention] The invention was made in view of the above points,
It has a simple and inexpensive structure, is versatile enough to be used in combination with various types of general urinary endoscope sheaths, and is strong enough to withstand heavy use. It is an object of the present invention to provide a prostate dissector for a urinary endoscope, which is equipped with a dissector capable of dissecting affected tissue with force.

[Summary of the invention] The prostate dissector for a urinary endoscope of the present invention includes a separator body having a through hole for inserting a scope insertion portion therein and a tip shaped like a ladle, and this separator body. A hand member is provided at the rear end of the scope guide pipe and has a connecting part for connecting with the sheath and a connecting part for connecting with the scope. The scope guide pipe and the hand member are integrally constructed to form a stripper, and after inserting this stripper into the sheath from the sheath hand portion, the scope is inserted into the separator from the separator hand portion. This is a stripping device that can perform stripping treatment while visually checking the affected area, and has excellent strength because the stripping element and scope are disposed coaxially within the sheath.

[Embodiments of the invention] Hereinafter, embodiments of the invention will be described based on the drawings.

4 to 6 relate to the first embodiment of the present invention,
FIG. 4 is a sectional view showing a state in which a mandolin is combined with a sheath of a cystourethroscope to which the present invention is applied;
Fig. 5 is a cross-sectional view showing a state where the stripper according to the present invention is inserted into the cystourethroscope sheath in combination with a scope, and Fig. 6 is a perspective view showing an enlarged distal end portion of the cystourethroscope shown in Fig. 5. be.

In FIG. 4, the sheath 13 is composed of a hollow and elongated sheath insertion portion 14 that is inserted into the ureter, etc., and a sheath proximal portion 15, and a mandoline 16 is inserted into the sheath 13 from the sheath proximal portion 15 and assembled. , the sheath tip 14a is closed. After inserting it into the urethra in this state, the mandolin 16 is removed, and a tubular separator 17 is inserted from the sheath proximal portion 15, as shown in FIG. The stripper 17 is composed of a stripper body 18, a scope guide pipe 19 connected to the stripper body 18, and a hand member 20 connected to the rear end of the scope guide pipe 19.
The scope guide pipe 19 and the hand member 20 are integrally constructed. And the separator body 18
is the insertion section 22 of the scope 21 as shown in FIG.
It has a through hole 18a for passing through, and the tip is formed into a ladle shape. The through hole 18a of the separator body 18 communicates with the inner cavity of the scope guide pipe 19 and the through hole of the hand member 20. Hand member 2
0 is provided with a connecting portion 20a for connecting with the sheath proximal portion 15 and a connecting portion 20b for inserting and connecting the scope 21 at both ends thereof. The peeler 17 has
The scope 21 is attached by inserting the insertion portion 22 of the observation scope 21 through the rear end connecting portion 20b of the hand member 20. scope 2
1 is composed of an eyepiece part 23 and a scope insertion part 22, and is further provided with a light source connection part 24, and a peeler is passed from the eyepiece part 23 through the scope insertion part 22 using light provided from the light source. The front end of the main body 18 can be viewed directly.

As shown in FIG. 4, the cystourethroscope constructed in this manner is inserted into the urethra with the mandoline 16 assembled to the sheath 13, and then the mandoline 16 is inserted into the sheath 13.
6, as shown in FIG.
Sheath 13 with scope 21 assembled to 7
Insert and secure. Then, while looking directly through the scope 21, insert the stripper main body 18 together with the sheath 13 and scope 21 between the intraprostatic gland and the external gland, and move the stripper main body 18 forward as one body while swinging the tip of the stripper main body 18 up and down. Proceed to separate the internal glands from the external glands.

7 and 8 relate to a second embodiment of the present invention; FIG. 7 is a sectional view showing a state in which the stripper according to the present invention is combined with a scope and inserted into the sheath of a resect scope; FIG. 7 is an enlarged perspective view of the distal end portion of the resectoscope shown in FIG. 7. FIG.

In FIG. 7, the resect sheath 25 includes a resect sheath insertion portion 26 and a resect sheath proximal portion 27.
The resect sheath insertion portion 26 has a distal end portion 26a molded from an insulating material such as epoxy resin or ceramic at the distal end of an outer tube made of metal such as brass or stainless steel. Further, the resect sheath proximal portion 27 is provided with a grip 28, and the resect sheath insertion portion 2 is attached to the grip 28.
A water intake port 29 communicating with 6 is formed to allow perfusion. A tubular separator 30 is inserted into the resect sheath 25 from the open end of the resect sheath proximal portion 27. When inserting into the urethra, a mandolin is attached to the resect sheath 25 from the resect sheath proximal part 27 as in the case of FIG.
The mandoline is inserted into the urethra in a state where the tube a is occluded, the mandoline is removed from this state, and the tubular stripper 30 is inserted through the sheath proximal portion 27. The stripper 30 is composed of a stripper main body 31 and a hand member 33 connected to the rear end of a scope guide pipe 32 connected to the stripper main body 31. are integrally constructed to form a tube body. As shown in FIG. 8, the separator main body 31 has a through hole 31a through which the insertion portion 35 of the scope 34 is inserted, and the distal end thereof is formed into a ladle shape. The through hole 31a of the separator body 31 communicates with the inner cavity of the scope guide pipe 32 and the through hole of the hand member 33. The hand member 33 has a resect sheath hand portion 2 at each end thereof.
7 and a connecting portion 33b into which the scope 34 is inserted and connected. The peeler 30 has a rear end connecting portion 3 of the hand member 33.
Insertion part 3 of scope 34 for observation further than 3b
5 and attach the scope 34. The scope 34 is composed of an eyepiece part 36 and a scope insertion part 35, and is further provided with a light source connection part 37. Light supplied from the light source passes from the eyepiece part 36 through the scope insertion part 35 to the peeler main body. 31 so that you can see directly in front of you.

In a resect scope configured like this,
When inserting into the urethra, the mandolin is assembled to the resect sheath 25 and inserted into the urethra, as in the case of the cystourethroscope. After removing the mandoline, the scope 34 is attached to the stripper 30 as shown in FIG. The assembled state is inserted and fixed into the resect sheath 25. Then, while looking directly through the scope 34, insert the stripper main body 30 together with the resect sheath 25 and the scope 34 between the intraprostatic gland and the external gland, and move the stripper main body 30 forward as one body while shaking the tip of the stripper main body 30 up and down. , detaching the internal gland from the external gland.

In both the peelers shown in FIGS. 6 and 8, the tip of the peeler bodies 18 and 31 is formed into a roughly ladle shape, but as shown in FIGS. 9 and 10, there is a slit in the tip. The separator main body is formed in a shape having a shape such that the underside of the separator main body can be observed.

FIG. 9 shows a third embodiment of the present invention of a stripper, in which a slit 18b for observation is provided in the longitudinal direction of the stripper 17 at the distal end portion of the main body 18 of the tubular stripper 17 used in the cystourethroscope shown in FIG. The slit 18b is formed approximately in the center so that the lower side of the main body 18 can be observed through the slit 18b.

FIG. 10 shows a fourth embodiment of the stripper according to the present invention, in which a stripper 30 is attached to the distal end portion of the main body 31 of the tubular stripper 30 used in the resectoscope shown in FIG.
A slit 31b for observation is formed in the longitudinal direction of the body 31, and the main body 31 is passed through this slit 31b.
It is configured so that the underside can be observed.

In addition, in FIGS. 9 and 10, a slit is provided in the peeler body as a means for observing the lower side of the peeler body, but the peeler body 1 shown in FIGS. 6 and 8 is
8 and 31 may be formed of transparent members so that the lower side of the separator main body can be seen through.

[Effects of the invention] As described above, according to the invention, the peeler can be
Since the stripper is arranged coaxially with the scope within the sheath, the stripper becomes an intermediate member that connects the sheath and the scope, making it a simple, robust, and inexpensive stripper for urinary endoscopes. equipment can be provided. In addition, by appropriately selecting the outer diameter of the stripper, it can be used in combination with other urinary endoscope sheaths, such as the cystourethroscope sheath, making it highly versatile. effective.

[Brief explanation of the drawing]

Fig. 1 is an overall view of the resectoscope, Fig. 2 is a perspective view showing an example of the distal end of a conventional resectoscope's prostatic dissection device, Fig. 3 is a front view of Fig. 2, and Figs. Figure 6 relates to the first embodiment of the present invention, Figure 4 is a sectional view showing a state in which a mandolin is combined with the sheath of a cystourethroscope, and Figure 5 is a cross-sectional view showing a state in which a mandolin is combined with a sheath of a cystourethroscope. 6 is an enlarged perspective view of the distal end portion of the cystourethroscope shown in FIG. 5, and FIGS. 7 and 8 relate to a second embodiment of the present invention. , FIG. 7 is a cross-sectional view showing a state in which the stripper according to the present invention is inserted into the sheath of the resectoscope in combination with a scope, and FIG. 8 is a perspective view showing an enlarged distal end portion of the resectoscope in FIG. 7. Figure, No. 9
The figure is a perspective view showing a third embodiment of the separator according to the present invention, and FIG. 10 is a perspective view showing a fourth embodiment of the separator. 13, 25... Sheath, 14, 26... Sheath insertion portion, 14a... Cystourethroscope sheath tip, 2
6a...Resect sheath tip, 15, 27...
Sheath proximal portion, 17, 30... Stripper, 18, 3
1...Separator body, 18b, 31b...Slit, 19, 32...Scope guide pipe, 20,
33... Stripper proximal part, 20a, 33a... Sheath connection part, 20b, 33b... Scope connection part,
21, 34... Scope, 22, 35... Scope insertion section, 23, 36... Eyepiece section.

Claims (1)

[Scope of utility model registration request] A urinary endoscope having a sheath to be inserted into the urethra, and for inserting a scope and a separator into the sheath and dissecting the intraprostatic glands from the external glands with the separator while looking directly through the scope, The separator includes a separator body whose tip is shaped like a ladle and has a through hole therein for inserting the insertion portion of the scope, and a separator body that supports the separator body and allows the insertion portion of the scope to be inserted therethrough. scope guide pipe for
A hand member is provided at the rear end of the scope guide pipe and includes a connecting portion for connecting to the sheath and a connecting portion for connecting the scope, and the separator and the scope are connected to each other within the sheath. A prostate ablation device for a urinary endoscope, characterized in that it is arranged coaxially.