WO2016021269A1 - Système de collecte de tissu - Google Patents

Système de collecte de tissu Download PDF

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Publication number
WO2016021269A1
WO2016021269A1 PCT/JP2015/064463 JP2015064463W WO2016021269A1 WO 2016021269 A1 WO2016021269 A1 WO 2016021269A1 JP 2015064463 W JP2015064463 W JP 2015064463W WO 2016021269 A1 WO2016021269 A1 WO 2016021269A1
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WO
WIPO (PCT)
Prior art keywords
channel
sheath
pipe
needle
operation unit
Prior art date
Application number
PCT/JP2015/064463
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English (en)
Japanese (ja)
Inventor
克次 上道
康彦 菊地
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to JP2015551641A priority Critical patent/JP5893814B1/ja
Publication of WO2016021269A1 publication Critical patent/WO2016021269A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters

Definitions

  • the present invention relates to a tissue collection system.
  • This application claims priority based on Japanese Patent Application No. 2014-160724 for which it applied to Japan on August 6, 2014, and uses the content here.
  • an inspection method called biopsy in which a small amount of body tissue is collected and observed with a microscope, is known.
  • a tissue may be collected by inserting a biopsy needle (see, for example, Patent Document 1).
  • an endoscope apparatus provided with a channel for inserting a treatment tool such as a biopsy needle (see, for example, Patent Document 2), the channel moves toward the side of the endoscope operation unit in the endoscope operation unit. It is known to include a fitting pipe for maintaining an inclined state.
  • An endoscope apparatus such as an ultrasonic endoscope has a channel for inserting a treatment tool such as a biopsy needle and a suction conduit for sucking a liquid or a tissue piece in the body.
  • a treatment tool such as a biopsy needle
  • a suction conduit for sucking a liquid or a tissue piece in the body.
  • a small-diameter insertion portion may be configured by sharing a part of the channel as a suction conduit.
  • a branch portion that branches into the channel and the suction conduit is provided in the endoscope operation portion.
  • the distal end of the channel of the ultrasonic endoscope is opened from the proximal end.
  • the biopsy needle meanders at a branch portion between the channel and the suction pipe, and the biopsy needle is broken or crushed (hereinafter referred to as “kink”).
  • kink a branch portion between the channel and the suction pipe
  • the present invention has been made in view of the circumstances described above, and its purpose is to prevent the occurrence of a sheath kink at the branch between the suction conduit and the channel arranged in the endoscope operation section, and It is to provide a tissue collection system that can be smoothly inserted into a channel.
  • a tissue collection system includes a channel, an endoscope operation unit provided with an opening on the proximal end side of the channel, and an aspiration for branching from the channel inside the endoscope operation unit And a branch portion that is a boundary portion between the channel and the suction conduit and forms a shape in which the channel is bent and forms a substantially Y-shaped conduit shape together with the suction conduit
  • An endoscopic apparatus having a treatment instrument operating unit connected to the proximal end side opening, a sheath connected to the treatment instrument operating unit and inserted into the channel, a needle tube inserted into the sheath so as to be able to advance and retreat, and A support pipe that covers the proximal end portion of the sheath and is connected to the distal end portion of the treatment instrument operation portion, and the distal end is disposed in the branch portion when the treatment instrument operation portion is fixed to the proximal end side opening.
  • a biopsy needle device having, Provided.
  • the treatment instrument operation unit and the support pipe are fixed to each other in a state in which the rotation with respect to the channel around the long axis of the sheath is restricted.
  • the support pipe may have an opening through which the sheath can be passed on the side facing the suction conduit in a state where the support pipe is located in the branch portion.
  • the support pipe may be harder than the sheath.
  • tissue collection system in which a sheath kink hardly occurs at a branching portion between a suction conduit and a channel disposed in an endoscope operation unit, and the channel can be smoothly inserted. it can.
  • FIG. 1 is an overall view of a tissue collection system according to a first embodiment of the present invention. It is sectional drawing of the front-end
  • FIG. 1 is an overall view of a tissue collection system according to this embodiment.
  • FIG. 2 is a cross-sectional view of the distal end portion of an ultrasonic endoscope that is an endoscope of the tissue collection system according to the present embodiment.
  • FIG. 3 is a cross-sectional view of the operation unit of the ultrasonic endoscope.
  • a tissue collection system 150 is a medical device that can be used for a biopsy to collect a body tissue.
  • the tissue collection system 150 includes an ultrasonic endoscope (endoscope device) 100 and an endoscopic biopsy needle device 1 (hereinafter simply referred to as “biopsy needle device”).
  • an ultrasonic endoscope 100 includes an insertion portion 101 that is inserted into the body from the distal end, an operation portion (endoscope operation portion) 109 that is attached to the proximal end of the insertion portion 101, and an operation.
  • Universal cord 112 having one end connected to the side of section 109, light source device 113 connected to the other end of universal cord 112 via branch cable 112a, and branch cable 112b to the other end of universal cord 112
  • the connected optical observation unit 114 and the ultrasonic observation unit 115 connected to the other end of the universal cord 112 via a branch cable 112c are provided.
  • 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.
  • image sensor such as a CCD or CMOS that detects an image of a subject incident through the imaging optical system
  • Various components 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. Further, the ultrasonic scanning mechanism 104 of the present embodiment is used 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 is pulled in a predetermined direction by pulling the angle wire (not shown) that is fixed to the distal end 105a (see FIG. 2) of the bending portion 105 and extends to the operation portion 109. It is an active bending part which curves to the side.
  • the bending portion 105 of this embodiment can be bent in two directions along the ultrasonic scanning direction.
  • the outer diameter of the insertion portion 101 is thin, and the bending portion 105 can be bent in two directions.
  • the outer diameter of the insertion portion 101 may be large, and the bending portion 105 may be bent in four directions.
  • the degree of freedom of operation of the ultrasonic endoscope 100 is higher than when the bending portion 105 can be bent in two directions.
  • 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.
  • a channel 107 is provided inside each of the bending portion 105 and the flexible tube portion 106.
  • the channel 107 shown in FIGS. 1 and 2 is a cylindrical portion for inserting the biopsy needle device 1. Furthermore, the channel 107 of this embodiment is used as a part of a suction conduit for sucking a liquid such as a body fluid.
  • the opening on the distal end side of the channel 107 is opened in the vicinity of the distal end portion of the distal end hard portion 102.
  • the proximal end side opening of the channel 107 is opened on the side surface on the distal end side of the operation unit 109.
  • a base end cap 108 formed in a flange shape is fixed to the base end side opening of the channel 107.
  • the biopsy needle device 1 used with the ultrasonic endoscope 100 can be fixed to the proximal end cap 108.
  • 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.
  • a part of a branching unit 120 described later also functions as a part of the channel 107.
  • 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 located at a position included in the ultrasonic scanning surface (substantially the same as the curved surface described above) by the ultrasonic scanning mechanism 104. For this reason, when the biopsy needle device 1 is inserted through the slope portion 107a, the slope portion 107a can guide the needle tube 3 of the biopsy needle device 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.
  • 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, for example, 23 degrees to 28 degrees.
  • the angle tube 107b is bent at a predetermined angle in order to change the direction of the tip of the biopsy needle device 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.
  • the angle tube 107b has an arc shape bent with a constant curvature.
  • the channel tube 107c is open 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. It extends to the proximal end side of the insertion portion 101 and is fixed to the branch portion 120.
  • the operation unit 109 includes a bending operation mechanism 110 for pulling the angle wire to cause the bending unit 105 to bend, a switch 111 for performing suction through the channel 107, and a channel.
  • a Y-shaped branch portion 120 (see FIG. 3) from which 107 is branched is arranged.
  • the branch part 120 includes a first pipe part 121 extending toward the distal end side of the operation part 109 and a second pipe part 122 extending coaxially with the first pipe part 121 from the proximal end of the first pipe part 121. And a third pipe part 123 extending from the base end of the first pipe part 121 in an inclined manner with respect to the first pipe part 121.
  • the first conduit section 121 is a conduit through which the inserted body 2 of the biopsy needle device 1 is inserted (see FIG. 7) and the aspirated body fluid or tissue passes.
  • the distal end of the first conduit portion 121 communicates with the proximal end of the channel tube 107c.
  • the second conduit section 122 is a suction conduit through which the aspirated body fluid or tissue passes.
  • the third conduit portion 123 is a conduit for guiding the insert 2 of the biopsy needle device 1 to the channel tube 107c.
  • a proximal end portion of the third conduit portion 123 is connected to the proximal end cap 108.
  • the angle formed by the first pipe part 121 and the third pipe part 123 is larger than the limit angle at which the needle tube 3 is kinked. This limit angle is determined according to the material and dimensions of the needle tube 3. Since the angle formed by the first pipe part 121 and the third pipe part 123 is an obtuse angle, the sheath 7 inserted into the channel 107 from the base end cap 108 is moved from the third pipe part 123 to the first pipe part. 121 can be guided.
  • the branch part 120 is connected to the first pipe part 121 and the third pipe.
  • a hollow region is provided at the boundary portion with the path portion 123. Since the branch portion 120 has a hollow region, the needle tube 3 can be in a gently curved state. Therefore, the angle formed by the first conduit portion 121 and the third conduit portion 123 is the limit angle at which kinking occurs in the needle tube 3. Can be prevented.
  • the limit angle at which kinking occurs in the needle tube 3 is determined according to the material and dimensions of the needle tube 3.
  • the angle formed by the first pipe part 121 and the third pipe part 123 is determined in consideration of the limit angle at which kinking occurs in the needle tube 3 corresponding to the usage mode of the needle tube 3.
  • the light source device 113 shown in FIG. 1 is a device for emitting illumination light necessary for imaging by the optical imaging mechanism 103.
  • the optical observation unit 114 displays the video imaged by the image sensor of the optical imaging mechanism 103 on the monitor 116.
  • the ultrasonic observation unit 115 receives the signal output from the ultrasonic scanning mechanism 104, generates an image based on this signal, and displays the image on the monitor 116.
  • FIG. 4 is a partial cross-sectional view showing the biopsy needle device 1 of the tissue collection system 150.
  • FIG. 5 is a diagram illustrating an operation unit of the biopsy needle device 1.
  • the biopsy needle device 1 includes an insertion body 2 (see FIG. 4) to be inserted into the body, and an operation unit (treatment instrument operation unit) for operating the insertion body 2. ) 8 and a stylet (core metal) 27.
  • the insertion body 2 is a long member that can protrude from the distal end of the insertion portion 101 of the ultrasonic endoscope 100 and can be attached to the channel 107.
  • 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.
  • an alloy material such as a stainless alloy, a nickel titanium alloy, or a cobalt chromium alloy can be employed.
  • An opening 31 for aspirating the tissue inside the needle tube 3 is formed at the tip of the needle tube 3.
  • the opening 31 is sharply formed to puncture the needle tube 3 into the living tissue.
  • 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 3 obliquely with respect to the axis X1 of the needle tube 3.
  • the specific shape of the opening 31 may be appropriately selected from various known shapes in consideration of the target tissue and the like.
  • the sheath 7 shown in FIG. 4 is made of a flexible tubular member.
  • the sheath 7 has a tubular shape through which the needle tube 3 can be passed through by winding a metal wire in a coil shape.
  • the sheath 7 may be made of resin.
  • the sheath 7 may have a resin coating.
  • the sheath 7 extends from the tip of the operation unit 8.
  • 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 and 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.
  • a slide lock 51 that can be attached to and detached from the proximal end cap 108 of the ultrasonic endoscope 100 is provided.
  • 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 substantially parallel, and the distance is set to a certain value so that the distal end side of the operation portion 109 of the ultrasonic endoscope 100 can be accommodated without contact.
  • a support pipe 53 made of stainless steel protrudes from the distal end portion of the sheath adjuster 18. As shown in FIG. 7, the support pipe 53 is inserted from the proximal end cap 108 of the ultrasonic endoscope 100 into the third conduit portion 123. In a state in which the biopsy needle device 1 is fixed to the base end cap 108, the distal end of the support pipe 53 is in the inner region of the inner wall of the first pipeline portion 121 when viewed from the center line direction of the first pipeline portion 121. It is in the position that entered.
  • the distal end of the support pipe 53 is located at a position separated from the inner wall of the first conduit portion 121.
  • the distance between the distal end of the support pipe 53 and the inner wall of the first duct portion 121 does not exceed twice the outer diameter of the sheath 7. For this reason, the sheath 7 extending from the support pipe 53 to the distal end side does not enter the second conduit portion 122 in a state where the biopsy needle device 1 is fixed to the proximal end cap 108.
  • the support pipe 53 In a state where the support pipe 53 is inserted into the third pipe section 123 and the biopsy needle device 1 is fixed to the proximal end cap 108, the support pipe 53 is coaxial with the center line of the third pipe section 123. It is supported by the three pipe sections 123. For this reason, the sheath 7 that advances and retreats with respect to the support pipe 53 has an obtuse angle formed by the first pipe part 121 and the third pipe part 123 when the support pipe 53 is supported by the third pipe part 123. Advancing and retreating along.
  • the needle pipe in the branch part 120 in a state where the needle pipe 3 is arranged in the sheath 7. No 3 kinks occur.
  • the proximal end portion of the support pipe 53 is inserted into the operation main 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. 5) 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 main body 9.
  • the sheath 7 is inserted into the support pipe 53, and the base end portion of the sheath 7 protrudes from the base end of the support pipe 53 and is fixed to the operation body 9 by adhesion or the like.
  • a fixing screw 54 is attached to the sheath adjuster 18 as shown in FIG.
  • 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.
  • 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 can be fixed so that the sheath adjuster 18 and the operation main body 9 do not slide.
  • 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.
  • the protrusion length can be fixed by the screw 54.
  • 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.
  • the fixing screw 54 since the fixing screw 54 is not biased left and right when the operation unit 8 is positioned in front of the operator, it can be easily operated regardless of the operator's dominant hand. If the axis of the fixing screw 54 is directed toward the axis of the operation unit 109 that is accommodated in the holder 52, the same effect can be obtained even if the fixing screw 54 is attached to the sheath adjuster 18 in the opposite direction to FIG. Can be obtained.
  • 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 the needle slider 23 can be fixed to the operation body 9 by tightening the fixing screw 62. As shown in FIG.
  • 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.
  • the fixing screw 62 since the fixing screw 62 is not biased left and right when the operation unit 8 is positioned in front of the operator, it can be easily operated regardless of the operator's dominant hand.
  • 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.
  • 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, so that 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.
  • the maximum protruding length from can be adjusted.
  • the operation stroke length L2 of the needle tube 3 by the needle slider 23 is at least 40 mm.
  • the needle slider 23 is located on the proximal end side of the operation main body 9, and the needle slider 23 is positioned on the most proximal end side that can be taken with respect to the operation main body 9. ing.
  • the tip of the needle tube 3 is in the sheath 7.
  • the sheath 7 is attached to the channel 107 of the ultrasonic endoscope 100 and the distal end portion of the sheath 7 can be optically observed using the ultrasonic endoscope 100, the distal end of the needle tube 3 is The bending portion 105 is located on the distal end side with respect to the distal end 105a.
  • 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. 4). 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. ) And the amount of expansion or contraction of the needle tube 3 is added.
  • the amount of expansion or contraction of the needle tube 3 depends on the stretchability (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 sheath 7. It is affected by the meandering state of the needle tube 3.
  • the tip of the needle tube 3 protrudes from the tip of the sheath 7.
  • the protruding length of the needle tube 3 in the initial state is shorter than the operation stroke length L2 of the needle slider 23, but is preferably at least 40 mm.
  • 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.
  • the stylet 27 shown in FIG. 4 has 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.
  • FIG. 6 is a perspective view showing a state in which the biopsy needle device 1 and the ultrasonic endoscope 100 are attached.
  • 7 to 10 are explanatory diagrams showing the operation of the tissue collection system 150.
  • FIG. Hereinafter, a biopsy procedure in which a lesion located in a deep part of the lung is used as a target tissue and the needle tube 3 of the biopsy needle device 1 is inserted and the cells of the lesion are collected through the needle tube 3 will be described as an example.
  • 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.
  • the surgeon inserts the insert 2 of the biopsy needle device 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.
  • the insert 2 reaches the branch part 120 from the base end cap 108, is bent and deformed from the third pipe part 123 toward the first pipe part 121, and is inserted into the channel tube 107c (see 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 a slide lock provided on the operation unit 8 of the biopsy needle device 1. 51 is engaged with the base end cap 108. Accordingly, the operation unit 8 of the biopsy needle device 1 is fixed to the ultrasonic endoscope 100 so as not to rotate with respect to the operation unit 109.
  • 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.
  • the operator tightens the fixing screw 54 to fix the protrusion amount.
  • 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.
  • the surgeon advances the needle slider 23 toward the distal end side of the operation unit 8.
  • the needle tube 3 protrudes from the sheath 7.
  • the operator advances the needle slider 23 toward the distal end side of the operation unit 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 guided to the sheath 7. While passing through the angle tube 107b, it reaches the slope portion 107a.
  • the tip of the needle tube 3 is also as described above. Is projected from the tip of the sheath 7 while being guided by the sheath 7.
  • 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.
  • the needle tube 3 exposed to the outside from the surface of the tissue can be observed by the optical imaging mechanism 103, and the tip side portion of the needle tube 3 inserted into the tissue is observed by the ultrasonic scanning mechanism 104. Can do.
  • 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.
  • 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.
  • 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.
  • the slide lock 51 is removed from the proximal end cap 108 of the operation unit 109 of the ultrasonic endoscope 100, and the biopsy needle device 1 is removed from the channel 107.
  • the ultrasonic endoscope 100 is removed from the patient, and the series of treatments is completed.
  • the support pipe 53 prevents the insertion body 2 from being bent toward the second conduit section 122. For this reason, it is prevented by the support pipe 53 that the insertion body 2 enters into the 2nd pipe line part 122 side. As a result, the needle tube 3 disposed inside the insert 2 is difficult to kink.
  • the support pipe 53 supports the insert 2 so that the insert 2 moves along the center lines of the first conduit portion 121 and the third conduit portion 123. The possibility that the insert 2 is complicatedly plastically deformed in the branching portion 120 when advancing and retreating in the channel 107 can be suppressed low.
  • FIG. 11 is a cross-sectional view showing a state in which the biopsy needle device 1A of the embodiment is fixed to the operation unit 109 of the ultrasonic endoscope 100 in the tissue collection system of the present embodiment.
  • FIG. 12 is an explanatory diagram showing the operation of the tissue collection system of this embodiment.
  • the biopsy needle device 1 ⁇ / b> A of the present embodiment has a shape in which a part of the outer peripheral surface of the distal end portion is cut out instead of the support pipe 53 (see FIG. 7) described in the first embodiment. It has a supporting pipe 53A.
  • the distal end portion of the support pipe 53A has a wall surface located on the second pipe section 122 side and faces the second pipe section 122 (first side).
  • An opening 53Aa through which the sheath 7 can pass is provided on the side of the pipe line part 121).
  • the support pipe 53 ⁇ / b> A is fixed to the operation unit 8 in a state where the rotation with respect to the channel 107 around the long axis of the sheath 7 is restricted.
  • the support pipe 53 ⁇ / b> A is regulated so that the support pipe 53 ⁇ / b> A does not rotate in the third conduit portion 123 when the biopsy needle device 1 ⁇ / b> A is fixed to the proximal end cap 108.
  • the distal end of the support pipe 53 ⁇ / b> A may be in contact with the inner surface of the first conduit portion 121.
  • the insertion body 2 is not bent due to the obtuse angle formed by the first pipeline portion 121 and the third pipeline portion 123.
  • the insert 2 protrudes out of the support pipe 53A from the notch formed in the tip portion of the support pipe 53A, so that the insert 2 forms a gentler curved shape than in the first embodiment. And bent in the branch part 120.
  • the kink of the needle tube 3 is more unlikely to occur, and the options of the applicable needle tube 3 are wide. Further, since the frictional resistance between the support pipe 53A and the sheath 7 is reduced, the sheath 7 can be smoothly advanced and retracted in the channel 107.
  • the insertion body 2 is prevented from entering the second conduit section 122 side by the support pipe 53A.
  • the possibility that the insert 2 is complicatedly plastically deformed in the branching portion 120 when advancing and retreating in the channel 107 can be suppressed low.
  • FIG. 13 is a cross-sectional view showing a state in which the biopsy needle device 1B of the same embodiment is fixed to the operation unit 109 of the ultrasonic endoscope 100 in the tissue collection system of the present embodiment.
  • the biopsy needle device 1B of the present embodiment has a support pipe 53B instead of the support pipe 53 described in the first embodiment.
  • the indicator pipe 53B includes a rigid pipe 55a on the proximal end side and a flexible pipe 55b on the distal end side.
  • the rigid pipe 55a is a cylindrical member configured to be supported coaxially with the third conduit portion 123 by the third conduit portion 123.
  • the rigid pipe 55 a is fixed to the operation unit 8.
  • the soft pipe 55b is a cylindrical member that is more flexible than the hard pipe 55a.
  • the flexible pipe 55 b has such a length that the tip of the flexible pipe 55 b is in contact with the inner wall of the first pipe line part 121.
  • the flexible pipe 55b faces the distal end side of the first conduit portion 121 along the inner wall of the first conduit portion 121 when the biopsy needle device 1B is fixed to the proximal end cap 108. It is deformed to be gently curved.
  • the flexible pipe 55b supports the needle tube 3 in the branch portion 120 so as to have a gently curved shape in which the needle tube 3 does not kink. For this reason, the insert 2 can be smoothly advanced and retracted in the channel 107.
  • the support pipe 53 may be harder than the insert 2 or may be more flexible than the insert 2.
  • the support pipe 2 can reinforce the insert 2 when the insert 2 is inserted therein.
  • tissue collection system in which a sheath kink hardly occurs at a branch portion between a suction conduit and a channel arranged in an endoscope operation unit, and the channel can be smoothly inserted. Can do.

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  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Optics & Photonics (AREA)
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  • Endoscopes (AREA)

Abstract

Le système de collecte de tissu de l'invention est équipé : d'un canal ; d'une partie manipulation d'endoscope dans laquelle est agencée une ouverture côté extrémité de base dudit canal ; d'un conduit pour absorption bifurquant dudit canal dans la partie interne de ladite partie manipulation d'endoscope ; et d'un dispositif d'endoscope qui possède une partie bifurcation constituant une portion interface entre ledit canal et ledit conduit pour absorption, telle que ledit canal prend une forme courbe, et prenant une forme de conduit sensiblement en forme de Y avec le conduit pour absorption. En outre, ce système de collecte de tissu est équipé : d'une partie manipulation d'instrument de traitement connectée à ladite ouverture côté extrémité de base ; d'une gaine connectée à ladite partie manipulation d'instrument et insérée dans ledit canal ; d'un tube d'aiguille inséré de manière à autoriser son avancée et son recul dans ladite gaine ; et d'une aiguille à biopsie qui revêt une partie extrémité de base de ladite gaine et est connectée à une partie extrémité avant de ladite partie manipulation d'instrument de traitement, et qui possède un tuyau de soutien dont l'extrémité avant est placée à l'intérieur de ladite partie bifurcation lorsque ladite partie manipulation d'instrument de traitement est fixée à ladite ouverture côté extrémité de base.
PCT/JP2015/064463 2014-08-06 2015-05-20 Système de collecte de tissu WO2016021269A1 (fr)

Priority Applications (1)

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JP2015551641A JP5893814B1 (ja) 2014-08-06 2015-05-20 組織採取システム

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JP2014160724 2014-08-06
JP2014-160724 2014-08-06

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2018153445A (ja) * 2017-03-17 2018-10-04 オリンパス株式会社 内視鏡
JPWO2017175280A1 (ja) * 2016-04-04 2019-02-28 オリンパス株式会社 内視鏡用処置具

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2006141810A (ja) * 2004-11-22 2006-06-08 Olympus Corp 内視鏡
JP2006187471A (ja) * 2005-01-06 2006-07-20 Olympus Medical Systems Corp 内視鏡用処置具

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2006141810A (ja) * 2004-11-22 2006-06-08 Olympus Corp 内視鏡
JP2006187471A (ja) * 2005-01-06 2006-07-20 Olympus Medical Systems Corp 内視鏡用処置具

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPWO2017175280A1 (ja) * 2016-04-04 2019-02-28 オリンパス株式会社 内視鏡用処置具
US10973501B2 (en) 2016-04-04 2021-04-13 Olympus Corporation Endoscopic treatment tool and handle
JP2018153445A (ja) * 2017-03-17 2018-10-04 オリンパス株式会社 内視鏡

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JPWO2016021269A1 (ja) 2017-04-27

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