JPS62268548A - Exclusion treatment tool - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] [Industrial application field] Regarding removal treatment tools.

[Problems to be solved by conventional techniques and inventions] In recent years,
Endoscopes, which have a length of 10 in length and can be used to observe the inside of a body cavity without making an incision from the body surface and to perform therapeutic treatment using a treatment instrument, have become widely used.

The endoscopes include flexible endoscopes, which have a flexible insertion section and are inserted through the oral cavity, etc., and rigid endoscopes, which have a rigid insertion section and are guided by a trocar, etc., and are inserted toward the observation target site in the body cavity. There is a mirror.

By the way, the rigid endoscope (
A laparoscope) is inserted into the body cavity through a trocar, and while the inside of the body cavity is observed endoscopically, treatment can be performed using various treatment instruments inserted into the body cavity through other trocars. Although this is widely practiced, when performing a treatment using the above-mentioned treatment instrument, the target area to be treated may be disturbed by the surrounding tissues or the Q device, and the treatment instrument may not be able to be introduced to the target area, or the treatment instrument may not be able to reach the target area. In some cases, appropriate treatment may not be possible. In such cases, conventionally, the other 1~
A trocar was punctured into the abdomen, and another surgical instrument was inserted into the body cavity through the trocar, and the procedure was carried out while moving the obstructive tissues or organs aside.

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

In this figure, a surgeon 1 uses an endoscopic vL4 inserted into a body cavity 3 through an endoscopic trocar 2 punctured into the patient's abdomen 11 to open a patient's body I! While observing the inside of 23, remove the abdomen 1.
The treatment is performed using a treatment instrument 6 inserted into the body cavity 3 through a treatment instrument trocar 5 punctured in the body cavity 3. Further, next to the surgeon 1, an assistant 7 observes the inside of the body cavity 3 with a reflexoscope 8 connected to the endoscope 4, and inserts a 1-Lacar 9 for an elimination treatment tool punctured into the abdomen 11. The removal treatment instrument 10 inserted into the body cavity 3 eliminates tissues or organs (not shown) that are preventing the treatment instrument 6 from being introduced to the target site or are interfering with the treatment.

In this way, conventionally, in order to exclude obstructive tissues and organs, the trocar 9 for the removal treatment instrument must be inserted into the patient's abdomen 11 etc., in addition to the trocar 2 for the endoscope and the trocar 5 for the treatment instrument. However, there is a problem in that more damage (force) is caused to the abdomen 11.

In addition, in the 81-person surgery, the operator is unable to perform the treatment with the treatment instrument 6 while removing obstructive tissues and organs with the removal treatment instrument 10 under the observation of the endoscope VL4. Two people are required, and the two surgeons separately handle 6 treatment instruments and 1
When operating the removal station 1i tool 10, there are problems in that it is difficult to perform appropriate treatment, and treatment efficiency and workability 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 liaison organs that obstruct the treatment of the target area, reduce damage to the patient, and improve the efficiency of treatment. The object of the present invention is to provide an exclusion treatment tool that can improve workability.

[Means and effects for solving the problem] The removal treatment instrument according to the present invention includes a hollow outer tube, a movable member inserted into the outer tube so as to be movable in the axial direction, and having a treatment instrument passage therein. This transfer Jet is provided on the rear end side of this moving member.
an operating means for moving the S material; and an operating means provided on the distal end side of the movable member, which can be freely protruded and retracted from the distal end of the outer tube by the movement of the movable member; It is equipped with an exclusion member that has a characteristic that the distal end side sometimes expands.

In the exclusion treatment instrument according to the present invention, by moving the movable member in the distal direction with respect to the outer tube using the operating means, the exclusion member is made to protrude from the distal end of the outer tube, and the distal end side of the exclusion member is expanded. . Then, the treatment can be performed with the treatment instrument inserted into the treatment instrument passage inside the movable member while eliminating surrounding fl$'J or organs that obstruct the treatment with this expanded exclusion member. I'm trying to make it possible.

[Embodiment] FIGS. 1 to 3 relate to an embodiment of the present invention, in which FIG. 1 is a sectional view of the removal treatment instrument, FIG. 2 is a sectional view taken along line A-A' in FIG. 1, and FIG. The figure is a cross-sectional view of the distal end side of the removal treatment instrument in a state of use.

In the removal treatment instrument 21 of the present embodiment, a hollow inner tube 23 as a movable member is freely inserted into an elongated hollow outer tube 22 whose outer diameter is on the right side so that it can be inserted into a trocar (not shown). There is. An inner tube 23 is provided at the If:2 end of the outer tube 22.
An operation section main body 24 is connected to the right through a hollow portion into which the operation section can be inserted. In the front part 9 of this operation part main body 24, there is a finger rest part 2.
4a is formed. Further, on the outer peripheral portion of the rear end side of the inner tube 23, a thick cylindrical operating member 25, for example, which can be moved with a finger is fixed. Between the front end of the operating member 25 and the rear end of the operating section main body 24, an operating section 25 is provided.
A spring 26, such as a coil spring, is interposed to bias the operation section body 24 rearward.

The operating portion main body 24, the operating portion 25, and the spring 26 constitute an operating means for moving the inner tube 23 in the axial direction.

Further, on the outer circumferential portion of the inner tube 23, a ratchet h is provided from the position where the operating portion 25 is fixed to the middle of the distal end side.
iji 27 is formed in the axial direction. On the other hand, the operating portion main body 24 has a portion cut out on the rear end side, and a ratchet pawl 28 that can be engaged with the ratchet if 27 is disposed in this cut portion. This ratchet pawl 2
8 is rotatably supported on the operating section main body 24 by a rotating shaft 29. Further, this ratchet pawl 28 is biased clockwise by a leaf spring 30 fixed to the operating section main body 24, and its rotation in the clockwise direction is restricted by the operating section main body 24. is engaged with the ratchet groove 27 to restrict the movement of the inner tube 23, so that the inner tube 23 can be fixed at any position relative to the outer tube 22.

As shown in FIG. 2, at the tip of the inner tube 23, for example, two exclusion members 31, 31 made of a round bar-shaped elastic material with a spherical tip are fixed. The removal member 31 is moved from the outer tube 22 by the movement of the inner tube 23.
In the state where it is pushed out from the tip of and immersed in the outer tube 22,
When the outer tube 22 is in a straight line along the inner wall thereof and protrudes from the distal end of the outer tube 22, the distal end side is biased to expand as shown in FIG. By arbitrarily setting the protrusion of the expulsion member 31 from the tip of the outer tube 22, the expansion distance (2) of the expulsion member 31 can be arbitrarily set variably.

Further, a treatment instrument passage 32 is formed inside the inner tube 23 in a hollow portion of the inner tube 23 .

A treatment instrument insertion port 34 is provided at the rear end of the inner tube 23.
Turn a to the right and enter the treatment instrument passage 32! A rubber cap 34 is provided to maintain airtightness when the 2!1 fixture 35 is inserted.

Next, the operation of the embodiment with the above configuration will be explained with reference to FIG. 3.

For example, an endoscope (not shown) inserted into a body cavity through a trocar (not shown)! When performing a treatment with a treatment tool under observation, the treatment tool 35 is inserted into the treatment tool passage 32 in the inner tube 23 of the removal treatment tool 21 of this embodiment, and the removal member 31 is inserted into the outer tube 22. In this state, the removal treatment instrument 21 is inserted into the body cavity through a trocar (not shown). Then, the treatment instrument 35 is made to protrude from the tips of the inner tube 23 and the outer tube 22, and the target region 36 is treated. When performing this treatment, if the tissue 37 around the target site 36 interferes with the advancement of the treatment instrument 35 or the treatment, the operation member 25 may be
It moves toward the tip side with respect to the operating section main body 24 against the spring 26.
IJ operation is performed to move the inner tube 23 toward the distal end with respect to the outer tube 22. As a result, the exclusion member 31 protrudes from the distal end of the outer tube 22, and its distal end side is expanded. Exclusion part 4431
By widening the 1/1 division member 31,
Surrounding tissue 37 that would obstruct the treatment of the target site 36 can be moved aside, making it easier to perform treatment with the treatment instrument 35.

In this embodiment, the inner tube 23 is connected to the outer tube 22 by a ratchet mechanism including a ratchet l:i 27 and a ratchet pawl 28.
The projecting foot of the expulsion member 31 from the tip of the outer tube 22 can be set arbitrarily. It can be set arbitrarily depending on the situation.

When drawing the exclusion member 31 into the outer tube 22 or reducing the amount of expansion of the exclusion member 31, the ratchet pawl 28 is rotated counterclockwise against the biasing force of the leaf spring 30. By doing so, this ratchet pawl 28
and the ratchet groove 27. Then, the inner tube 23 moves rearward due to the biasing force of the spring 26, and the removal member 31 is drawn into the outer tube 22.

In this way, according to this embodiment, the treatment instrument 35 can be inserted into the treatment instrument passage 32 within the inner tube 23, so that the treatment instrument 35 can be inserted through one trocar while eliminating tissues or organs that would interfere with the treatment. , each treatment can be performed on the target area, and damage to the patient can be reduced. In addition, a single person can remove tissues or organs that interfere with the treatment and perform the treatment using a treatment instrument using an endoscope, improving treatment efficiency and workability. Ru.

In this embodiment, the inner tube 23 is fixed to the outer tube 22 by a ratchet mechanism consisting of a ratchet groove 27 and a ratchet pawl 28, but as shown in FIG.
A fixing screw 3 is inserted into the hollow part from the outer periphery of the operating part main body 24.
8 may be used to fix the inner tube 23.

Further, the movable member is not limited to the inner tube 23, and may be a rod-shaped member that is movable along the inner wall of the outer tube 22, for example.

Further, the shape of the exclusion part 031 is not limited to a round bar shape, and may be, for example, a plate shape or a cylindrical shape with a plurality of slits on the tip side, and the number of exclusion members 31 is not limited to two. , one tree, or three or more trees.

In addition, a rubber cap 34 that maintains airtightness when inserting the treatment instrument
Instead of f-J, a cock is installed to open and close the treatment instrument passage 32.
It's okay.

Further, the spring 26 is not limited to a coil spring, but may be a temporary spring or the like, and the spring that biases the ratchet pawl 28 clockwise is not limited to the leaf spring 30, for example, around the rotation f*29. A torsion coil spring may be provided.

As an example of various treatment instruments used in combination with the removal treatment instrument 21 according to the present invention, there are ligation treatment instruments as shown in FIGS. 5 to 7.

FIG. 5t is a cross-sectional view of the ligature holder, FIG. 6 is a right-hand side view of FIG. 5, and FIG. 7 is a front view of the ligature.

This ligature treatment tool is composed of a ligature holder 42 and a ligature 43.

The ligature probe)) The shell 42 is provided with a hollow insertion tube 45 that has a ligature passageway 44 on the inside, and a distal end side insertion hole 46 that communicates with the ligature passageway 44 on the distal end side of the insertion tube 45.
A tip member 47 is fixedly provided on the right side. The distal end surface of the distal end member 47 is formed into a spherical shape, and the inner diameter of the distal end side insertion hole 46 is smaller than the inner diameter of the ligature passageway 44.

On the other hand, on the rear end side of this insertion tube 45, the ligature passage 4
A front main body 48 is connected to the right side of the hollow portion communicating with the main body 4. A Luer lock shaped connection part 48a is formed at the rear end of this front body/I8, and this Luer lock shaped connection part '1
A rear main body 49 is detachably connected to 8a. After this, on the tip side of the four main bodies, the Luer lock shaped connecting portion 4 is attached.
8a is inserted into an annular cross section! : The l'i portion 50 is provided in the axial direction. A female thread 50a is screwed into the outer surface of this groove 50, and the four rear bodies and the front body 48 are connected by screwing the Luer lock-shaped connecting portion 48a into this female thread 50a. In addition, the four rear bodies are provided with a proximal insertion hole 51 and a slit 52 that communicate with the ligature passageway 44 in order from the distal end side, and a slit 52 is provided below the center of the slit 52 as shown in FIG. "Show"
, sea urchin, guide for positioning the ligature 43)
jΔ52a is provided. Further, the four main bodies are provided with fixing screws 5 that pass through the slits 52 from the outer periphery.
3 is provided, and the tip surface of this fixing screw 53 and the slit 5
The ligature 43 can be clamped and fixed between the end surfaces of 2 and 2.

The ligature 43, as shown in FIG. 7, consists of one thread and is tied to form a ligature 54 on the distal end side. The knot 55 is formed in a size that does not allow it to pass through the distal end side insertion hole 46 of the shell 42. By pulling the proximal side portion 56 with the knot 55 fixed, the size of +Q54 is reduced.

To perform ligation treatment using this ligation treatment tool, first,
Insert the proximal side portion 56 of the ligature 43 into the ligature passage 44 through the distal side insertion hole 46 of the ligature probe 4 shell 42, roughly pass through the proximal side insertion hole 51 and the slit 52, and insert it into the rear body 49. Pull it out from the rear end.

Then, with the thread 54 of the ligature 43 protruding from the distal end of the distal end member 47, the proximal portion 56 of the ligature 43 is positioned by the guide ring 52a and fixed with the fixing screw 53.

In this state, for example, 98 of the removal treatment instrument 21 according to the present invention
The insertion tube 45 is inserted into the gastric shell passageway 32, and the ligature 43 is introduced into the body cavity. Then, the ligature 43 is placed over the area (not shown) that requires ligation for purposes such as hemostasis. Next, by rotating the four rear bodies with respect to the front body 718, the four rear bodies are removed from the front body 48, and the rear body 49 is pulled and fixed to the rear body 49 with the screws 53. The ligature 43 is pulled. Then, since the knot 55 of the ligature 43 cannot pass through the tip insertion hole 46, it is locked to the tip member 47, and the loop 54 gradually becomes smaller, so that the knot 55 of the ligature 43 is not able to pass through the tip insertion hole 46, and the loop 54 gradually becomes smaller. can be ligated.

It goes without saying that this ligation treatment instrument can also be directly inserted into a body cavity via a trocar or the like.

Furthermore, the removal treatment tool 21 according to the present invention is not limited to the ligation treatment tool described above, and various treatment tools such as forceps, hemostatic tools, cutting tools, etc. can be used in combination.

[Effects of the Invention] As explained above, according to the present invention, it is possible to protrude and retract from the distal end of the outer tube the exclusion member, which has a characteristic that the distal end side expands when protruding from the distal end of the outer tube. So,
Surrounding tissues or organs that would interfere with treatment of the target area can be removed, and since a treatment instrument passage is provided inside the movable member, it is possible to remove surrounding tissues or organs that would interfere with treatment and treat the target area. It can be performed through a single lacquer of one piece of wood, and has the effect of reducing damage to the patient.

In addition, the removal of tissues or organs that interfere with the treatment and the treatment using the treatment instrument can be performed by one person under the observation of an endoscope, improving the efficiency and workability of the treatment. There is an effect that it can be done.

[Brief explanation of the drawing]

Figures 1 to 3 relate to one embodiment of the present invention, in which Figure 1 is a sectional view of the removal treatment instrument, Figure 2 is a sectional view taken along line A-A in Figure 1, and Figure 3 is in use. FIG. 4 is a cross-sectional view of the vicinity of the operation unit main body showing a modification of one embodiment, and FIGS. 5 to 7 are cross-sectional views of the distal end side of the exclusion treatment instrument of the present invention. Regarding an example of a treatment tool, FIG. 5 is a sectional view of a ligature holding shell, FIG. 6 is a right side view of FIG. 5,
FIG. 7 is a front view of the ligature, and FIG. 8 is an explanatory diagram showing an example of a conventional treatment under observation with an endoscope. 21... Exclusion treatment tool 22... Outer tube 23... Inner tube 24... Operating section main body 25... Operating member 27... Ratchet groove 28... Ratchet pawl 31... Excluding member 32...Treatment instrument passage Figure 5 Figure 6 Figure 7 Figure 8 Procedure Neichi New Year's Day 1 (Voluntary) July 30, 1985 Director General of the Special Medical Examination Agency Uga Michibu Tono 1, Display of matter A'1 1986 IrojfmF petition No. 1
1192382, title of the invention Elimination treatment device 3, case related to the person making the amendment Patent applicant representative Satoshi Shimoyama Part 1, page 11 of the specification, lines 9 to 11, ``Also, treatment ``When inserting the treatment instrument...2 + 9Ω may be applied.'' In addition, in addition to the rubber gap 34 that maintains airtightness when inserting the treatment instrument, a cock that opens and closes the treatment instrument passage 32 is added. If installed, airtightness will be further ensured.''

Claims (1)

[Claims] a hollow outer tube; a movable member inserted into the outer tube so as to be movable in the axial direction and having a treatment instrument passage therein; and an operation means provided at the rear end of the movable member for operating the movable member. and is provided on the distal end side of the movable member, and has a characteristic that when the movable member moves, it can be freely protruded and retracted from the distal end of the outer tube, and that the distal end side expands when protruding from the distal end of the outer tube. What is claimed is: 1. An exclusion treatment tool comprising: an exclusion member provided with the following.