WO2015190187A1

WO2015190187A1 - Endoscopic treatment instrument and biopsy system

Info

Publication number: WO2015190187A1
Application number: PCT/JP2015/062956
Authority: WO
Inventors: 克次上道; 雄次坂本
Original assignee: オリンパス株式会社
Priority date: 2014-06-10
Filing date: 2015-04-30
Publication date: 2015-12-17
Also published as: CN205234537U

Abstract

An endoscopic treatment instrument is provided with an insertion body and an operation part. The insertion body comprises a needle tube, said needle tube being reciprocally operated by the operation part, and a sheath into which the needle tube is inserted. The sheath comprises a flexible outer cylinder part and a coiled inner cylinder part, said inner cylinder part being fixed at such a position that the inner cylinder part can be interposed between the top end of the needle tube on the inner surface of the outer cylinder part and the outer cylinder part. When the top end of the sheath is positioned so that the top end of the sheath can be optically observed by an endoscope and the needle tube is moved by the operation part to the limit in the basal end side of the sheath, the basal end of the inner cylinder part is positioned between the basal end of a slope part and the basal end of a curving part of the endoscope and closer to the top end than the basal end of the curving part, and the top end of the needle tube is positioned within the inner cylinder part.

Description

Endoscopic treatment tool and biopsy system

The present invention relates to an endoscope treatment tool and a biopsy system.
This application claims priority based on Japanese Patent Application No. 2014-119522 for which it applied to Japan on June 10, 2014, and uses the content here.

Conventionally, an inspection method called biopsy, in which a small amount of body tissue is collected and observed with a microscope, is known. When collecting deep tissue such as organs, it is difficult to observe with an optical endoscope, so an ultrasonic tomographic image of the organ is obtained with an ultrasonic endoscope, etc., and a biopsy needle is taken into the organ under ultrasonic observation. The tissue may be collected by inserting the.

Patent Document 1 describes a biopsy treatment tool used for such applications. This treatment instrument includes a tubular needle tube having a sharp tip, and when the needle tube is inserted into the tissue, a part of the tissue enters the needle tube. By removing the needle tube, the tissue that has entered the inside can be collected.

Japanese Patent No. 3890013

In a biopsy technique using a conventional biopsy needle as described in Patent Document 1, an endoscope is first introduced in the vicinity of a target tissue, and a channel is placed at a position where a needle tube can be suitably inserted into the target tissue. The bending amount of the bending portion where the tip opening and the ultrasonic scanning mechanism can be positioned is specified. Thereafter, the bending is temporarily released, and a treatment instrument including a biopsy needle is inserted into the channel, and an operation is performed to bend again by this bending amount. However, when the treatment instrument is inserted into the channel, the insertion portion becomes difficult to bend due to the rigidity of the needle tube, and even if the bending operation is performed to the maximum, this bending amount may not be obtained and the procedure may not be continued.

The target tissue on which the biopsy technique is performed is not limited to the digestive tract as disclosed in Patent Document 1 above, and the biopsy technique is performed on, for example, the respiratory tract. An endoscope used for a biopsy for a respiratory organ has a small diameter and a small bending force at a bending portion as compared with a general endoscope for a digestive tract. The influence of the difficulty of bending due to the rigidity of the biopsy needle disclosed in Patent Document 1 is more in comparison with a biopsy for the digestive tract when a biopsy for the respiratory tract is performed using an endoscope. Become prominent.

The present invention has been made in view of the above-described circumstances, and an object thereof is to provide an endoscopic treatment tool and a biopsy system that have little influence on the bending function of the endoscope.

According to the first aspect of the present invention, an endoscope treatment tool includes an insertion portion that is inserted into a body, a slope portion that is provided near a distal end of a channel and is inclined with respect to an axis of the insertion portion, An endoscopic treatment tool that can be attached to an endoscope comprising an active bending portion provided on a proximal end side of the slope portion, and is inserted into the channel and passes through the slope portion An insert that can project from a distal end of the insertion portion, and an operation portion that is disposed at a proximal end of the insert. The insert has a needle tube that has a distal end that can puncture tissue and is advanced and retracted by the operation unit, and a sheath through which the needle tube is inserted and attached to the operation unit. The sheath is a flexible outer cylinder part, and a coiled inner cylinder part fixed at a position where it can be interposed between the tip of the needle tube and the outer cylinder part on the inner surface of the outer cylinder part And having. In a state where the distal end of the sheath is in a position where it can be optically observed by the endoscope, and in a state where the operation unit moves the needle tube to the proximal end side of the sheath to the limit, The proximal end is located on the distal side of the active bending portion between the proximal end of the slope portion and the proximal end of the active bending portion, and the distal end of the needle tube is the inner cylinder Located in the department.

According to the second aspect of the present invention, in the endoscope treatment tool according to the first aspect, the length of the inner cylinder part in the center line direction of the inner cylinder part is relative to the sheath with respect to the sheath. It may be shorter than the stroke length.

According to the third aspect of the present invention, the biopsy system may include the endoscope treatment tool and the endoscope according to the first aspect. The endoscope may include an ultrasonic scanning mechanism that acquires an ultrasonic image of the needle tube at the distal end of the insertion portion. The slope portion may be formed so as to be inclined so that an opening on a tip side of the channel is directed to a scanning surface of the ultrasonic scanning mechanism, and the insertion body may be guided to the scanning surface. The channel includes the slope portion, a channel tube extending along an axial direction of the insertion portion, and an angle portion connecting the slope portion and the channel tube so that the slope portion is inclined with respect to the channel tube. You may have. In the state where the distal end of the sheath is in the position where it can be optically observed by the endoscope, and the operation unit moves the needle tube to the proximal end side of the sheath to the limit, The inner cylinder portion may extend from the slope portion to the channel tube in a state of being bent or bent at the angle portion.

According to the present invention, it is possible to provide an endoscope treatment tool and a biopsy system that have little influence on the bending function of the endoscope in a state in which the endoscope treatment tool is attached to the endoscope.

1 is an overall view of a biopsy system including an endoscope treatment tool according to an embodiment of the present invention. It is sectional drawing of the front-end | tip part of the ultrasonic endoscope which is an endoscope of the biopsy system of the embodiment. It is sectional drawing of the front-end | tip part of the said treatment tool for endoscopes. It is sectional drawing which shows the state in which the said treatment tool for endoscopes was attached to the said ultrasonic endoscope. It is a fragmentary sectional view showing the treatment tool for endoscopes. It is a figure which shows the operation part of the treatment tool for endoscopes. It is a perspective view which shows the attachment state of the said treatment tool for endoscopes, and the said ultrasonic endoscope. It is explanatory drawing which shows the effect | action of the said biopsy system. It is explanatory drawing which shows the effect | action of the said biopsy system. It is explanatory drawing which shows the effect | action of the said biopsy system.

An embodiment of the present invention will be described. First, an example of an ultrasonic endoscope used with an endoscope treatment tool (hereinafter simply referred to as “treatment tool”) 1 in the present embodiment will be described with reference to FIGS. 1 and 2. FIG. 1 is a diagram illustrating a schematic configuration of a biopsy system 150 according to the present embodiment including the treatment tool 1 and the ultrasonic endoscope 100. FIG. 2 is a cross-sectional view of the distal end portion of the ultrasonic endoscope 100 that is an endoscope of the biopsy system 150.

As shown in FIG. 1, the ultrasonic endoscope 100 includes an insertion portion 101 that is inserted into the body from the distal end, an operation portion 109 that is attached to the proximal end of the insertion portion 101, and one end at the side of the operation portion 109. Is connected to the other end of the universal cord 112 via the branch cable 112a, and the optical observation unit is connected to the other end of the universal cord 112 via the branch cable 112b. 114 and an ultrasonic observation unit 115 connected to the other end of the universal cord 112 via a branch cable 112c.

The insertion portion 101 includes a distal end hard portion 102, a bending portion 105, and a flexible tube portion 106 arranged in this order from the distal end side.

The distal end hard portion 102 includes an optical imaging mechanism 103 for optical observation and an ultrasonic scanning mechanism 104 for ultrasonic observation.

The optical imaging mechanism 103 is an imaging optical system whose field of view is directed diagonally forward of the hard tip portion 102, an image sensor such as a CCD or CMOS that detects an image of a subject incident through the imaging optical system, and the operation of the image sensor. Various components (not shown) such as a CPU to be controlled are provided.

The ultrasonic scanning mechanism (probe) 104 includes an ultrasonic transducer (not shown) that emits and receives ultrasonic waves. The ultrasonic scanning mechanism 104 receives the reflected wave reflected by the ultrasonic wave emitted from the ultrasonic vibrator when it hits the observation target, and observes the signal based on the ultrasonic wave received by the ultrasonic vibrator. Output to the unit 115. The ultrasonic scanning mechanism 104 of the present embodiment is used to acquire an ultrasonic image of a tissue that is a biopsy target, and to acquire an ultrasonic image of the needle tube 3 in the course of a biopsy procedure.

The bending portion 105 is formed in a cylindrical shape, and an active bending portion that bends in a predetermined direction by pulling the angle wire (not shown) that is fixed to the distal end of the bending portion 105 and extends to the operation portion 109 in the operation portion 109. It is. The bending portion 105 of this embodiment can be bent in two directions along the ultrasonic scanning direction.

In this embodiment, for example, an endoscope that has a thin outer diameter and can be bent in two directions is used for respiratory treatment. For example, when performing a digestive organ treatment, an endoscope that can be bent in four directions with a large outer diameter but a high degree of freedom of operation may be used.

The flexible tube portion 106 is a cylindrical member that is formed flexibly so that the distal end hard portion 102 can be guided to a desired position in the lumen tissue or the body cavity. Inside each of the bending portion 105 and the flexible tube portion 106, a channel 107 and a conduit (not shown) for performing air supply / water supply and suction are provided.

The channel 107 shown in FIGS. 1 and 2 is a cylindrical portion for inserting the treatment instrument 1. One end of the channel 107 is opened near the distal end portion of the distal end hard portion 102, and the other end of the channel 107 is opened on the side surface on the distal end side of the operation portion 109. A base end cap 108 formed in a flange shape is fixed to the other end of the channel 107. The treatment tool 1 used together with the ultrasonic endoscope 100 can be fixed to the proximal end cap 108.

As shown in FIG. 2, the channel 107 includes a slope portion 107a inclined with respect to the axis C1 of the insertion portion 101 in the distal end hard portion 102, and an angle tube 107b (angle portion) connected to the base end of the slope portion 107a. And a channel tube 107c connected to the proximal end of the angle tube 107b.

The slope portion 107a is provided in the distal end hard portion 102 by forming a through hole in the distal end hard portion 102 with a straight line inclined with respect to the axis C1 of the insertion portion 101 as a center line. The center line C2 of the through hole formed in the slope portion 107a is at a position included in the scanning surface of the ultrasonic scanning mechanism 104. For this reason, when the treatment instrument 1 is inserted through the slope portion 107a, the slope portion 107a can guide the needle tube 3 of the treatment instrument 1 to the above-described scanning plane. The inclination angle of the center line C2 of the slope portion 107a with respect to the axis C1 of the insertion portion 101 may be set as appropriate corresponding to the site to be treated. In the present embodiment, the center line C2 of the slope portion 107a is inclined with respect to the axis C1 of the insertion portion 101 at an angle of 26 degrees, for example.

The angle tube 107b is bent or bent at a predetermined angle in order to change the direction of the distal end of the treatment instrument 1 guided from the channel tube 107c to the slope portion 107a in a direction along the center line C2 of the slope portion 107a. It is a curved tube. The angle tube 107b connects the slope portion 107a and the channel tube 107c. In the present embodiment, the angle tube 107b has an arc shape bent with a constant curvature.

The channel tube 107c is opened toward the distal end side of the insertion portion 101 in a direction parallel to the direction of the axis C1 of the insertion portion 101 in the vicinity of the proximal end of the distal end hard portion 102, and is substantially parallel to the axis C1 of the insertion portion 101. The base portion 108 extends to the base end side of the insertion portion 101 and is fixed to the base end cap 108.

1 has an outer surface formed so that an operator who uses the ultrasonic endoscope 100 can hold it in his / her hand. The operation unit 109 includes a bending operation mechanism 110 for pulling the angle wire to cause the bending unit 105 to bend, and a plurality of switches 111 for supplying air, supplying water, or sucking through the conduit.

The light source device 113 is a device for emitting illumination light for imaging by the optical imaging mechanism 103.

The optical observation unit 114 is configured to display an image captured by the image sensor of the optical imaging mechanism 103 on the monitor 116.

The ultrasonic observation unit 115 is configured to receive a signal output from the ultrasonic scanning mechanism 104, generate an image based on the signal, and display the image on the monitor 116.

Next, the configuration of the treatment instrument 1 will be described. FIG. 3 is a cross-sectional view of the distal end portion of the treatment instrument 1. FIG. 4 is a cross-sectional view showing a state in which the treatment instrument 1 is attached to the ultrasonic endoscope 100. FIG. 5 is a partial cross-sectional view showing the treatment instrument 1. FIG. 6 is a diagram showing the operation unit 8 of the treatment instrument 1.

As shown in FIGS. 1 and 3, the treatment instrument 1 includes an insertion body 2 to be inserted into the body, an operation section (treatment instrument operation section) 8 for operating the insertion body 2, and a stylet (core metal). 27.

The insert 2 is a long member that can be attached to the channel 107 so as to protrude from the distal end of the insertion portion 101 of the ultrasonic endoscope 100. The insert 2 includes a needle tube 3 and a cylindrical sheath 7 into which the needle tube 3 is inserted.

The needle tube 3 is a cylindrical member that has a distal end and a proximal end, and is advanced and retracted by the operation unit 8. The material of the needle tube 3 is preferably a material that has flexibility and elasticity that can be easily restored to a linear state even when bent by an external force. For example, as the material of the needle tube 3, an alloy material such as a stainless alloy, a nickel titanium alloy, or a cobalt chromium alloy can be employed.

The tip of the needle tube 3 is formed with a sharp shape for piercing the tissue with the needle tube 3 and an opening 31 for sucking the tissue inside the needle tube 3. The opening 31 provided at the distal end of the needle tube 3 is formed by cutting off the distal end of the tubular member forming the needle tube obliquely with respect to its own axis X1, and is formed sharply so that it can be inserted into a living tissue. ing. The specific shape of the opening 31 may be appropriately selected from various known shapes in consideration of the target tissue and the like.

As shown in FIG. 3, the sheath 7 has an outer cylinder portion 71 made of resin and an inner cylinder portion 72 made of a metal coil.

The outer cylinder portion 71 is made of a flexible tubular member. The outer cylinder portion 71 extends from the tip of the operation portion 8. Outer cylinder part 71 may be formed with resin which has comparatively high flexibility among resin. For example, regarding the physical properties of the outer cylinder 71, the outer cylinder 71 exemplified in the present embodiment has a tensile strength of 20 MPa to 35 MPa, a Rockwell hardness of R20, a Shore hardness of D50 to D55, The flexural modulus is 0.53 GPa to 0.58 GPa, and the tensile modulus is 0.40 GPa to 0.60 GPa. Examples of the resin that can be used as the material of the outer cylinder portion 71 include fluororesins such as PTFE, high-density polyethylene, and the like. The outer cylinder part 71 is flexible to such an extent that it can be bent by the bending deformation of the insertion part 101 of the ultrasonic endoscope 100 shown in FIG. Further, the outer cylinder portion 71 has such a hardness that it is considered that the insertion body 2 is prevented from meandering excessively in a state where the insertion body 2 is inserted into the channel 107 (for example, see FIG. 4). Also good.

Although the outer cylinder part 71 illustrated in this embodiment is not preferable, it can expand and contract depending on the temperature. For example, the outer cylinder portion 71 exemplified in this embodiment has a linear expansion coefficient of 10 × 10 5 / ° C. Moreover, it is preferable that the material of the outer cylinder part 71 is selected in consideration of heat resistance, chemical resistance, and biocompatibility.

The hardness of the outer cylindrical portion 71 is such that the bending portion 105 can bend over the entire movable range of the bending portion 105 of the ultrasonic endoscope 100 in a state where the treatment instrument 1 is attached to the ultrasonic endoscope 100. May be set in consideration of In this case, the hardness is set in consideration of the hardness of the needle tube 3. Note that it is not essential that the bending portion 105 of the ultrasonic endoscope 100 is always capable of bending over the entire movable range.

As shown in FIG. 3, the inner cylinder portion 72 is fixed to the inner surface of the outer cylinder portion 71 in the vicinity of the tip of the outer cylinder portion 71. The position of the inner cylinder part 72 is a position where the inner cylinder part 72 can be interposed between the distal end of the needle tube 3 and the outer cylinder part 71 in the outer cylinder part 71. The inner cylinder portion 72 has a cylindrical shape that is coaxial (including substantially coaxial) with the outer cylinder portion 71. The inner cylinder part 72 has a distal end 72a at a position slightly away from the distal end 71a of the outer cylinder part 71 to the proximal end side, and is the same as the relative stroke length L1 of the needle tube 3 with respect to the sheath 7 (see FIG. 5 described later)? It is a cylindrical member shorter than the relative stroke length L1.

The position of the base end 72b of the inner cylinder part 72 is set corresponding to the structure of the ultrasonic endoscope 100 to which the treatment instrument 1 is attached. As shown in FIG. 4, the base end 72 b of the inner cylindrical portion 72 is such that the distal end 71 a of the outer cylindrical portion 71 is within the imaging field of view of the optical imaging mechanism 103 and at least a part of the sheath 7 can be observed by the optical imaging mechanism 103. When it is, it is in the base end side rather than the front-end | tip of the bending part 105 or the front-end | tip of the bending part 105. Further, the base end 72 b of the inner cylinder part 72 is located on the tip side of the base end of the bending part 105 when the tip 71 a of the outer cylinder part 71 is in the imaging field of view of the optical imaging mechanism 103.

The inner cylinder portion 72 is formed in a cylindrical shape into which the needle tube 3 can be inserted by winding a wire in a coil shape in a tightly wound manner. As a strand constituting the inner cylindrical portion 72, a strand having a circular cross section, a strand having an elliptical cross section, a strand having a rectangular cross section, or the like may be employed. The strands constituting the inner cylindrical portion 72 are wound in close winding, and the strands are fixed to the inner surface of the outer cylindrical portion 71 so that the outer cylindrical portion 71 is adjacent to each other. Is held by. It is preferable that the surface of the strand which comprises the inner cylinder part 72 is a shape which can prevent the tip of the needle tube 3 from being caught. Since the tip of the needle tube 3 is not easily caught by the inner cylinder portion 72, the tip of the needle tube 3 is difficult to be plastically deformed. As a result, the tip of the needle tube 3 is maintained in a sharp state where the needle tube 3 can be suitably punctured into the tissue.

The inner tube portion 72 prevents the needle tube 3 in the sheath 7 from breaking through the sheath 7 or damaging the inner surface of the outer tube portion 71 when the sheath 7 is deformed into a curved shape by the angle tube 107b. That is, since the strands constituting the inner cylinder portion 72 are closely wound, the needle tube 3 is difficult to enter between the strands. Since the tip of the needle tube 3 is unlikely to contact the inner surface of the outer cylinder portion 71, the needle tube 3 is unlikely to break through or damage the sheath 7.

Also, the inner cylindrical portion 72 prevents the lumen of the sheath 7 from being blocked when the sheath 7 is deformed into a curved shape by the angle tube 107b. For the inner cylinder portion 72, the cross-sectional shape, diameter, and material of the wire are selected so that the flexibility in the vicinity of the distal end of the sheath 7 is not greatly reduced.

As shown in FIGS. 5 and 6, the operation unit 8 includes an operation main body 9, a sheath adjuster 18 provided on the distal end side of the operation main body 9, and a needle slider 23 provided on the proximal end side of the operation main body 9. Is provided.

The operation body 9 is made of, for example, ABS resin. The operation body 9 has a lumen through which the needle tube 3 and the sheath 7 can be inserted. The distal end side of the operation body 9 is inserted into a sheath adjuster 18 formed in a tubular shape. The proximal end side of the operation body 9 is inserted into a needle slider 23 formed in a tubular shape. The operation main body 9 and the sheath adjuster 18, and the operation main body 9 and the needle slider 23 are engaged with each other by a groove or a projection (not shown) formed on the outer peripheral surface, so that relative rotation around the axis is suppressed, and the axial direction Is slidable.

At the distal end of the sheath adjuster 18, a slide lock 51 that can be attached to and detached from the proximal end cap 108 of the ultrasonic endoscope 100 is provided. By sliding the slide lock 51 in a direction perpendicular to the axis of the operation unit 8 and engaging the base end base 108, the operation unit 8 can be fixed to the ultrasonic endoscope 100. A holder (fixed portion) 52 having a pair of

wall portions

52 a and 52 b is provided on the distal end side of the slide lock 51. The holder 52 is fixed to the sheath adjuster 18. The pair of

wall portions

52a and 52b of the holder 52 are arranged substantially in parallel, and the distance is set to a value such that the distal end side of the operation unit 109 of the ultrasonic endoscope 100 is not rattled. .

A support pipe 53 made of, for example, stainless steel protrudes from the tip of the sheath adjuster 18. The distal end portion of the support pipe 53 is inserted into the channel 107 when the treatment instrument 1 is attached to the ultrasonic endoscope 100. The support pipe 53 is inserted into the operation body 9. The base end of the support pipe 53 is located closer to the base end side (for example, position P1 shown in FIG. 6) than the tip end of the needle slider 23 in a state where the needle slider 23 is most advanced with respect to the operation body 9. The sheath 7 is inserted into the support pipe 53, and the base end portion protrudes from the base end of the support pipe 53 and is fixed to the operation body 9 by adhesion or the like.

The fixing screw 54 is attached to the sheath adjuster 18. The fixing screw 54 passes through the sheath adjuster 18 and is fitted in a screw hole (not shown) provided in the operation main body 9. When the fixing screw 54 is tightened with respect to the operation main body 9, the sheath adjuster 18 is pressed against the operation main body 9, and the sheath adjuster 18 and the operation main body 9 can be fixed in a non-slidable manner. By changing the positional relationship between the sheath adjuster 18 and the operation main body 9, the protruding length of the sheath 7 from the channel 107 when the operation unit 8 is fixed to the ultrasonic endoscope 100 can be adjusted. This protrusion length can be fixed by the screw 54.

As shown in FIG. 1, the axis of the fixing screw 54 is preferably arranged so as to be directed to the axis of the operation unit 109 housed in the holder 52. Thereby, since the fixing screw 54 is not biased left and right when the operation unit 8 is positioned in the front, it can be easily operated regardless of the operator's dominant hand. As long as the axis of the fixing screw 54 is directed toward the axis of the operation unit 109 accommodated in the holder 52, substantially the same effect can be obtained even if the fixing screw 54 is attached to the opposite side of FIG.

The outer peripheral surface of the distal end portion of the sheath adjuster 18 is provided with irregularities so that the operator can easily grasp it.

The needle slider 23 is fixed to the proximal end of the needle tube 3. Further, the needle slider 23 is connected to the operation main body 9 so as to be movable with respect to the operation main body 9. Since the proximal end side of the needle tube 3 protrudes from the proximal end of the sheath 7 and is fixed to the needle slider 23, the needle tube 3 is moved from the distal end of the sheath 7 by sliding the needle slider 23 with respect to the operation body 9. Can be plunged. A stopper 61 is movably attached to the operation main body 9 at the distal end side of the needle slider 23. The stopper 61 has a fixing screw 62 and can be fixed to the operation body 9 by tightening the fixing screw 62. As shown in FIG. 1, the axis of the fixing screw 62 is preferably arranged so as to be directed to the axis of the operation unit 109 housed in the holder 52. Thereby, since the fixing screw 62 is not biased left and right when the operation unit 8 is positioned in front, it can be easily operated regardless of the operator's dominant hand. As long as the axis of the fixing screw 62 is directed toward the axis of the operation unit 109 that is accommodated in the holder 52, substantially the same effect can be obtained even if the fixing screw 62 is attached facing the opposite side to FIG.

The fixing screw 62 may be directed in the same direction as the fixing screw 54 described above, or may be directed in directions opposite to each other.

As shown in FIG. 5, the needle slider 23 can only move forward with respect to the operation main body 9 up to a position where it comes into contact with the stopper 61. For this reason, the maximum protrusion length from the sheath 7 of the needle tube 3 can be adjusted by adjusting the fixing position of the stopper 61 with respect to the operation main body 9. In the present embodiment, the operation stroke length L2 of the needle tube 3 by the needle slider 23 is at least 40 mm.

The state in which the needle slider 23 is located at the position where the needle slider 23 has moved to the limit on the proximal end side of the operation main body 9 (the position where the needle slider 23 is disposed on the most proximal side with respect to the operation main body 9). It is an initial state before the start of use. In the initial state, the tip of the needle tube 3 is in the sheath 7. More specifically, in the initial state, the distal end of the needle tube 3 is in the inner cylindrical portion 72, that is, between the distal end 72a and the proximal end 72b of the inner cylindrical portion 72.

The position of the tip of the needle tube 3 with respect to the sheath 7 in the initial state varies depending on the influence of the expansion or contraction of the sheath 7 and the extension or contraction of the needle tube 3. Variations in the position of the distal end of the needle tube 3 with respect to the sheath 7 are affected by temperature, humidity, the attachment state of the ultrasonic endoscope 100 to the channel 107, the amount of operating force applied to the treatment instrument 1, and the like.

For example, since the resin-made outer cylinder portion 71 and the metal needle tube 3 have different expansion coefficients corresponding to temperature changes, the needle slider 23 is moved to a position where the needle slider 23 has moved to the limit on the proximal end side of the operation body 9. Even in an initial state, the position of the needle tube 3 with respect to the sheath 7 varies depending on the temperature.

Also, in the process of inserting the insert 2 into the channel 107 (see FIG. 4), the resin-made outer cylinder 71 may be contracted more than the needle tube 3 due to the compressive force in the center line direction. In this case, in the state where the distal end of the insertion body 2 is guided to the distal end of the channel 107, the distal end of the needle tube 3 is positioned closer to the distal end of the sheath 7 than in the state where the insertion body 2 is not inserted into the channel 107. Is located.

In the present embodiment, considering the temperature, humidity, the state of attachment of the ultrasonic endoscope 100 to the channel 107, and the amount of operation force applied to the treatment tool 1, the initial state is assumed in the environment assumed as the procedure using the treatment tool 1. Then, as shown in FIG. 5, the length of the inner cylinder part 72 in the direction of the center line Y1 of the coil of the inner cylinder part 72 is determined so that the tip of the needle tube 3 is always in the inner cylinder part 72.

If the length of the inner cylindrical portion 72 in the direction of the center line Y1 of the coil of the inner cylindrical portion 72 is extremely long so that the inner cylindrical portion 72 is disposed over the entire length of the bending portion 105, the ultrasonic endoscope This causes the bending performance of the bending portion 105 of the mirror 100 to deteriorate.

The amount of movement of the needle slider 23 relative to the operation body 9 substantially corresponds to the amount of movement of the tip of the needle tube 3 relative to the sheath 7 (see FIG. 5). That is, when the needle slider 23 moves the needle tube 3 relative to the sheath 7, the movement amount (relative stroke length L1) of the needle tube 3 with respect to the sheath 7 is changed to the actual movement amount (operation stroke length L2) of the needle slider 23. ) Plus the expansion or contraction of the needle tube 3. The expansion or contraction of the needle tube 3 is the elasticity (elasticity) of the needle tube 3 itself, the magnitude of the frictional resistance between the needle tube 3 and the sheath 7, the meandering state of the sheath 7 in the channel 107, and the needle tube 3 in the sheath 7. Affected by the meandering state.

When the needle slider 23 is at the position where the needle slider 23 has moved to the limit on the distal end side of the operation body 9, the distal end of the needle tube 3 protrudes from the distal end of the sheath 7. The protruding length of the needle tube 3 when the needle slider 23 is at the position where the needle slider 23 has moved to the limit on the distal end side of the operation body 9 is shorter than the operation stroke length L2 of the needle slider 23, but may be at least 40 mm. preferable.

An opening 23 a is provided at the proximal end portion of the needle slider 23, and the stylet 27 can be inserted into the needle tube 3 from the proximal end of the needle tube 3. The opening 23a is provided with a thread, and a known syringe or the like can be connected to the opening 23a. The outer peripheral surface of the distal end portion of the needle slider 23 is provided with irregularities so that the operator can easily grasp it.

3 and 5 includes a knob 27a that can be attached to the opening 23a of the needle slider 23, and a core 27b fixed to the knob 27a. The core 27 b has a cross-sectional shape corresponding to the inner surface shape of the needle tube 3. In the present embodiment, the core 27b has a circular cross section.

The operation when using the biopsy system 150 having the above configuration will be described. FIG. 7 is a perspective view showing a state in which the treatment instrument 1 and the ultrasonic endoscope 100 are attached. 8 to 10 are explanatory diagrams showing the operation of the biopsy system 150. FIG. Hereinafter, a biopsy procedure in which a lesion located in the deep part of the lung is used as a target tissue and the needle tube 3 of the treatment instrument 1 is inserted and the cells of the lesion are collected through the needle tube 3 will be described as an example.

First, the operator inserts the insertion portion 101 of the ultrasonic endoscope 100 shown in FIG. 1 into the body, observes with the optical imaging mechanism 103, and appropriately inserts the insertion portion 101 to the vicinity of the target tissue while curving the bending portion 105. Introduce the tip. After the introduction, the surgeon determines a site to perform a biopsy based on the observation results by the optical imaging mechanism 103 and the ultrasonic scanning mechanism 104.

Next, the surgeon inserts the insertion body 2 of the treatment instrument 1 from the distal end side into the channel 107 from the proximal end cap 108 provided in the operation unit 109 of the ultrasonic endoscope 100. Furthermore, as shown in FIG. 7, the surgeon enters the distal end side of the operation unit 109 between the pair of

wall portions

52 a and 52 b of the holder 52, and then slide slide 51 provided in the operation unit 8 of the treatment instrument 1. Is engaged with the base end cap 108. Thereby, the operation unit 8 of the treatment instrument 1 is fixed to the ultrasonic endoscope 100 so as not to rotate with respect to the operation unit 109.

At this time, the treatment instrument 1 is in the above-described initial state, that is, the distal end of the needle tube 3 is in the inner cylinder portion 72. Therefore, the needle tube 3 guided in the channel 107 along the curved flexible tube portion 106 is protected by the inner tube portion 72 so that the tip of the needle tube 3 does not pierce the outer tube portion 71. Further, due to the frictional resistance between the inner surface of the channel 107 and the outermost surface of the insert 2, shrinkage due to compression may be accumulated in the sheath 7 as the insert 2 is pushed into the channel 107. In this case, the distal end of the sheath 7 moves to the proximal end side relative to the needle tube 3. In this case as well, the distal end of the needle tube 3 is protected by the inner cylindrical portion 72.

Next, the operator loosens the fixing screw 54 and observes the sheath 7 and the inside of the body with the optical imaging mechanism 103 and the ultrasonic scanning mechanism 104, and moves the sheath adjuster 18 and the operation body 9 relative to each other as shown in FIG. The amount of protrusion of the sheath 7 from the distal end of the insertion portion 101 of the ultrasonic endoscope 100 is adjusted to an appropriate amount. After the adjustment, the surgeon tightens the fixing screw 54 to fix the protruding amount.

Even after the amount of protrusion of the sheath 7 is adjusted, the tip of the needle tube 3 is in the inner cylinder portion 72. Further, the tip of the needle tube 3 is located at any position in the channel 107 between the curved portion 105 and the angle tube 107b, in the angle tube 107b, or in the slope portion 107a.

Next, based on the observation result by the ultrasonic scanning mechanism 104, the stopper 61 is moved in consideration of the distance to the target tissue T to be biopsied and fixed to the operation main body 9 at a desired position, and the maximum of the needle tube 3 is obtained. Adjust the protrusion length.

Next, as shown in FIG. 8, the surgeon advances the needle slider 23 toward the distal end side of the operation unit 8. Thereby, as shown in FIG. 9, the needle tube 3 protrudes from the sheath 7. When the operator advances the needle slider 23 toward the distal end side of the operation portion 8 with the distal end of the needle tube 3 between the curved portion 105 and the angle tube 107 b, the distal end of the needle tube 3 is the inner cylinder of the sheath 7. It passes through the angle tube 107b while being guided by the portion 72 and reaches the slope portion 107a. For this reason, the tip of the needle tube 3 does not pierce the outer tube portion 71 or damage the outer tube portion 71, and the tip portion of the needle tube 3 serving as the blade tip is not plastically deformed by the tip hard portion 102. It protrudes from the distal end of the sheath 7 in a good state where it can puncture tissue.

Even when the tip of the needle tube 3 is moved to the tip side starting from the angle tube 107b, and when the tip of the needle tube 3 is moved to the tip side starting from the slope portion 107a, the tip of the needle tube 3 is also as described above. Is excellent in that it can puncture a tissue without piercing the outer cylinder part 71 or damaging the outer cylinder part 71 and without plastically deforming the distal end portion of the needle tube 3 serving as a cutting edge by the distal end hard part 102. It protrudes from the tip of the sheath 7 in a state.

When the operator advances the needle slider 23 toward the distal end side of the operation unit 8, as shown in FIG. 10, the distal end of the needle tube 3 is punctured into the tissue and is pushed forward to the target tissue T to be biopsied. At this time, the needle tube 3 exposed to the outside from the surface of the tissue can be observed by the optical imaging mechanism 103. The tip side portion of the needle tube 3 inserted into the tissue can be observed by the ultrasonic scanning mechanism 104.

The surgeon can observe an ultrasonic image based on the ultrasonic wave received by the ultrasonic scanning mechanism 104 with the ultrasonic observation unit 115 shown in FIG. With reference to the image of the needle tube 3 clearly displayed on the ultrasonic observation unit 115, the operator causes the tip of the needle tube 3 to reach the target tissue T on which biopsy is performed.

Next, the surgeon pushes out the tissue that has not entered into the needle tube 3 and is not subjected to biopsy with the stylet 27, and pulls out the stylet 27 from the insert 2 and the operation unit 8. Thereby, a through hole extending from the distal end of the needle tube 3 to the proximal end of the needle slider 23 is generated. The surgeon connects a syringe or the like to the proximal end of the needle slider 23 and sucks the inside of the needle tube 3, and sucks and collects cells of the target tissue T to be biopsied from the tip of the needle tube 3.

When a necessary amount of cells and the like have been collected, the needle slider 23 is retracted toward the proximal end side of the operation unit 8 and the distal end of the needle tube 3 is accommodated in the sheath 7. Thereby, the needle tube 3 comes out of the tissue. When the needle tube 3 is removed from the tissue, the slide lock 51 is removed from the proximal end cap 108 of the operation unit 109 of the ultrasonic endoscope 100, and the treatment instrument 1 is removed from the channel 107. Finally, the ultrasonic endoscope 100 is removed from the patient, and the series of treatments is completed.

As described above, in the present embodiment, since the inner cylindrical portion 72 is configured to have a coil made of a strand, the inner cylindrical portion 72 can be bent, and the distal end of the needle tube 3 and the sheath 7 can be bent. Is protected by the inner cylinder portion 72. That is, since the inner cylinder portion 72 is fixed to the inner surface in the vicinity of the distal end of the outer cylinder portion 71, the distal end of the needle tube 3 is hardly plastically deformed in the process of projecting the distal end of the needle tube 3 from the distal end of the sheath 7, The tip of the needle tube 3 is difficult to break through the sheath 7.

Further, according to the treatment instrument 1 and the biopsy system 150 of the present embodiment, the outer cylindrical portion 71 of the sheath 7 has a flexible configuration so that the bending performance of the bending portion 105 is unlikely to deteriorate, and the inner cylindrical portion 72 includes the needle tube 3. It is the structure which can prevent the sheath 7 from being pierced by the tip. Furthermore, since the inner cylinder part 72 is mainly disposed in the distal end hard part 102, it is difficult to lower the bending performance of the bending part 105. For this reason, the sheath 7 suitably satisfies both the suppression of the decrease in the bending performance of the bending portion 105 and the prevention of the sheath 7 from breaking through the needle tube 3 in the process of attaching the treatment instrument 1 to the ultrasonic endoscope 100 and using it. Is possible.

Further, when the inner cylinder portion 72 is shorter than the relative stroke length L1 of the needle tube 3, the inner tube portion 72 is shortened within a range in which the sheath 7 can be prevented from being broken and the needle tube 3 can be punctured into the tissue. It is possible to set the length longer.

The treatment instrument 1 of the present embodiment is used in combination with the ultrasonic endoscope 100 having the slope portion 107a, so that the needle tube 3 moves into the tissue after the insertion body 2 of the treatment instrument 1 enters the slope portion 107a. It is possible to prevent deterioration of the puncture property due to the damage of the sheath 7 due to the bending deformation of the insert 2 and the damage of the tip of the needle tube 3 in the process until the puncture.

The embodiment of the present invention has been described in detail above with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within a scope not departing from the gist of the present invention are included.

For example, instead of the curved or bent cylindrical angle tube 107b, a curved or bent through hole (angle portion) may be formed in the distal end hard portion 102 in the same manner as the angle tube 107b. In this case, the angle tube 107b is unnecessary.

The present invention is not limited by the above description, and is limited only by the appended claims.

1 treatment tool (endoscopic treatment tool)
DESCRIPTION OF SYMBOLS 2 Insert 3 Needle tube 31 Opening of needle tube 7 Sheath 71 Outer cylinder part 71a Tip of outer cylinder part 72 Inner cylinder part 72a Tip of inner cylinder part 72b Base end of inner cylinder part 8 Operation part 9 Operation main body 18 Sheath adjuster 23 Needle slider 27 Stylet (Core)
27a Knob 27b Core 51 Slide lock 52 Holder (fixed part)
52a, 52b A pair of wall parts 53 Support pipe 54 Fixing screw 61 Stopper 62 Fixing screw 100 Ultrasound endoscope 101 Insertion part 102 Hard tip part 103 Optical imaging mechanism 104 Ultrasonic scanning mechanism 105 Bending part 106 Flexible pipe part 107 Channel 107a Slope part 107b Angle tube (angle part)
107c Channel tube 108 Base end 109 Operation unit 110 Bending operation mechanism 111 Multiple switches 112 Universal code 113 Light source device 114 Optical observation unit 115 Ultrasound observation unit 116 Monitor 150 Biopsy system

Claims

An internal view comprising: an insertion portion that is inserted into the body; a slope portion that is provided near the distal end of the channel and is inclined with respect to the axis of the insertion portion; and an active bending portion that is provided on a proximal end side of the slope portion. An endoscopic treatment tool that can be attached to a mirror,
An insert that is inserted into the channel and can pass through the slope portion and protrude from the tip of the insertion portion;
An operation unit disposed at a proximal end of the insert;
With
The insert is
A needle tube that has a tip that can be punctured into tissue and is advanced and retracted by the operation unit;
A sheath in which the needle tube is inserted and attached to the operation unit;
Have
The sheath is
A flexible outer cylinder,
A coiled inner tube portion fixed at a position where it can be interposed between the tip of the needle tube and the outer tube portion of the inner surface of the outer tube portion;
Have
In a state where the distal end of the sheath is in a position where it can be optically observed by the endoscope, and in a state where the operation unit moves the needle tube to the proximal end side of the sheath to the limit, The proximal end is located on the distal side of the active bending portion between the proximal end of the slope portion and the proximal end of the active bending portion, and the distal end of the needle tube is the inner cylinder Endoscopic treatment tool located in the department.
The endoscope treatment tool according to claim 1,
A treatment instrument for an endoscope, wherein a length of the inner cylinder portion in a center line direction of the inner cylinder portion is shorter than a relative stroke length of the needle tube with respect to the sheath.
The endoscope treatment tool according to claim 1,
An endoscope according to claim 1;
With
The endoscope has an ultrasonic scanning mechanism that acquires an ultrasonic image of the needle tube at the distal end of the insertion portion;
The slope portion is formed so as to be inclined so that the opening on the distal end side of the channel is directed to the scanning surface of the ultrasonic scanning mechanism, and the insertion body can be guided to the scanning surface,
The channel is
The slope portion;
A channel tube extending along the axial direction of the insertion portion;
An angle portion connecting the slope portion and the channel tube so that the slope portion is inclined with respect to the channel tube;
Have
In the state where the distal end of the sheath is in the position where it can be optically observed by the endoscope, and the operation unit moves the needle tube to the proximal end side of the sheath to the limit, The biopsy system, wherein the inner cylinder portion extends from the slope portion to the channel tube in a state of being bent or bent at the angle portion.