JP4320207B2 - Endoscopic resection aid - Google Patents

Description

[0001]
【Technical field】
The present invention relates to an endoscopic resection assisting device and an endoscopic treatment method using the resection assisting device that are used when, for example, a lesion is resected under endoscopic observation.
[0002]
[Prior art and its problems]
Conventionally, when excising a lesion inside a human body in a normal operation, the distance between the lesion and the adjacent normal tissue is widened by lifting the lesion using a grasping forceps, and the lesion and the normal tissue are in that state. It is excised between. However, for example, in endoscopic mucosal resection (EMR), since only one endoscope can be inserted into the body, the lesion cannot be lifted, and physiological saline is applied to the normal mucosa around the lesion with an injection needle. The lesion was lifted by injecting, and in that state, excision between the lesion and the normal mucous membrane was performed using a high-frequency knife or snare.
[0003]
However, in such a conventional method, the lesioned part could not be lifted to a sufficient position, and thus a sufficient excision part at the boundary between the lesioned part and the normal tissue could not be secured.
In addition, when the lesioned part has a flat shape, it may not be possible to create an excised part.
[0004]
Further, during the excision work, the already excised lesioned part may fall on the normal tissue, thereby obstructing the field of view by the endoscope, particularly when the lesioned part is large. For this reason, the excised part cannot be seen, and in order to remove it blindly, the normal part is damaged and complications such as perforation occur, blood vessels are damaged and major bleeding occurs. Since it could not be confirmed and hemostasis could not be achieved, serious complications could occur, and a safer device and treatment method were required.
[0005]
Therefore, in order to solve these problems, the present applicant arranges a hooking member for hooking a lesion inside the human body, a magnetic anchor made of a magnetic body connected to the hooking member, and an outside of the human body. A magnetic anchor guide device that generates a magnetic field and applies power to the magnetic anchor, and supplies the power to the magnetic anchor by the magnetic field generated by the magnetic anchor guide device, thereby causing the lesioned part that is hooked on the hook member to A magnetic anchor guiding device characterized by lifting is proposed and a patent application has been filed (Japanese Patent Application No. 2002-268239).
[0006]
However, in an endoscope using this magnetic anchor guidance device, while observing a lesion with the endoscope, the direction of the body's top, bottom, left and right is not known, or the direction of the magnetic field by the magnetic guidance device is Since it may not be understood, there is a problem that skill is required to move the lesioned part in a predetermined direction by the magnetic anchor.
Furthermore, since the magnetic anchor guidance device is an expensive device, there has been a demand for a device and a treatment method that can reliably excise a lesion at a lower cost.
[0007]
OBJECT OF THE INVENTION
SUMMARY OF THE INVENTION An object of the present invention is to provide an endoscopic resection assisting device capable of pulling a lesioned part in a predetermined direction during resection, and an endoscope using the resection assisting device, which is simple, reliable, and more inexpensive than conventional methods. It is in providing the treatment method by.
[0008]
Summary of the Invention
The endoscopic resection assisting device of the present invention includes a first hooking member that hooks a target portion inside a target object, and a first hooking member that is hooked inside the target object at a position different from the first hooking member . and 2 hooking member, connects the said first hooking member and the second hooking member, and the traction coupling member for pulling the first hooking member in the second hooking member side, by comprising It is a feature.
[0009]
The traction connecting member may be an elastic member that is engaged with the first hooking member and the second hooking member .
[0010]
It is practical that the elastic member is a rubber band that is engaged with the first hooking member and the second hooking member .
[0011]
Further, the elastic member may be a compression coil having hook portions that engage with the first hooking member and the second hooking member at both ends.
[0012]
Further, the traction connecting member comprises a flexible string part and at least three hook parts fixed to the string part in a longitudinal direction, and the hook part selects any two of them. In particular, the first hooking member and the second hooking member may be engaged with each other.
[0013]
It is practical that at least one of the first hooking member and the second hooking member is a clip that can be opened and closed and can clamp the target portion.
[0014]
The first hooking member and the second hooking member may have the same structure.
[0015]
The traction connecting member may be detachable from the first hooking member and the second hooking member.
[0016]
[0017]
[0018]
[0019]
[0020]
[0021]
[0022]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, a first embodiment of the present invention will be described in detail with reference to FIGS.
The resection assisting apparatus 1 according to the present embodiment includes a first clip 2, a second clip 3, and a rubber band 4.
[0023]
The first clip ( first hooking member ) 2 shown in FIGS. 1 and 5, etc. has a first base piece 2c in which a substantially arc-shaped engaging portion 2a is formed at one end and a tip portion 2b is formed at the other end. And a substantially linear second base piece 2e having a tip 2d formed at one end, and an adjustment member 2f fixed to the first base piece 2c and the second base piece 2e, respectively. The detailed structure of the adjusting member 2f is omitted, but the adjusting member 2f can be adjusted in the width direction. When the width is increased, the distal ends of the first base piece 2c and the second base piece 2e are adjusted. When the interval between 2b and 2d increases and the width decreases, the interval between the tip portions 2b and 2d decreases. The first clip 2 is a member for grasping and lifting a lesioned part (target part) X in a patient (target) body.
[0024]
Similarly the second clip (second hooking member) 3 shown in FIG. 1 and FIG. 2 or the like is a member of the same configuration as that of the first clip 2, similarly to the first clip 2, the pathological lesion portion X of the patient A body I can grab it.
[0025]
As shown in FIGS. 1 and 7, the rubber band (traction connecting member) (elastic member) 4 is engaged with the engaging portions 2 a and 3 a of the first clip 2 and the second clip 3, thereby both the clips 2. 3 are connected to each other.
FIG. 3 shows a bed 5 on which a patient A is placed.
[0026]
FIG. 4 shows an endoscope 10 used for performing excision using the excision assisting apparatus 1.
Since the structure of the endoscope 10 is well-known, detailed description thereof is omitted. However, as shown in FIG. 5 and the like, air supply / water supply for supplying air and cleaning water to the distal end surface 11a of the insertion portion 11 inserted into the body. There are provided a nozzle 12, an illumination window 13 for illuminating the excision part and the periphery thereof, an observation window 14 in which an objective lens is arranged for observing the excision part and the periphery thereof, and an outlet 15 of a forceps channel (not shown). Yes. The forceps channel is provided in the insertion portion 11, and its inlet 16 a is formed on the end face of the forceps insertion port protrusion 16.
[0027]
Next, the excision procedure of the lesioned part X using the excision assisting apparatus 1 will be described.
Prior to performing excision using the excision assisting apparatus 1, first, as shown in FIG. 3, the patient A that has undergone local anesthesia is laid on the bed 5.
Next, the overtube 20 shown in FIGS. 5 to 9 is inserted into the body of the patient A from the mouth of the patient A, and the tip of the overtube 20 is brought close to the lesion X in the organ B. Then, the insertion portion 11 of the endoscope 10 is inserted into the overtube 20, and the distal end portion thereof protrudes from the distal end of the overtube 20 so as to approach the lesioned portion X. As described above, when the distal end of the insertion portion 11 of the endoscope 10 is inserted into the organ B, an observation image in the organ B obtained from the observation window 14 is displayed on a television monitor (not shown).
[0028]
In this state, a tube-like treatment instrument (not shown) having an injection needle is inserted into the distal end portion from the inlet 16a of the forceps insertion port projection 16, and the injection needle is protruded from the outlet 15 of the insertion portion 11, The injection needle is inserted from the periphery of the lesion X into the submucosa B1 of the organ wall and physiological saline is injected, and the lesion X is lifted from the proper muscle layer B2.
[0029]
Next, the first clip 2, the second clip 3, and the rubber band 4 are individually inserted into the organ B of the patient A according to the procedure described below.
[0030]
First, outside the body of the patient A, the first clip 2 with the distal end portions 2b and 2d opened is fitted into the distal end opening portion of the flexible tube 30 made of an elastic material. The tube 30 is inserted into the forceps channel from the inlet 16a of the forceps insertion port projection 16, and the tip of the tube 30 protrudes from the outlet 15 of the forceps channel (see FIG. 5). Then, by operating the flexible tube 30, the first clip 2 Once close to the lesion X, flexible pushing rod tube 30 to are inserted beforehand (not shown) the extruded forward, the One clip 2 is dropped from the flexible tube 30 and placed near the lesion X (see FIG. 6).
[0031]
Next, although not shown, the flexible tube 30 is once pulled out of the forceps channel, and the second clip 3 in a state where the distal end portions 3b and 3d are opened outside the body at the distal end opening portion of the flexible tube 30. The second clip 3 is elastically gripped by the flexible tube 30, and the flexible tube 30 is inserted into the forceps channel from the inlet 16a of the forceps insertion port projection 16 in the state, and the distal end portion thereof. Project from the outlet 15 of the forceps channel. Next, when the flexible tube 30 is operated to bring the second clip 3 close to the lesioned part X, the pushing rod is pushed forward to drop the second clip 3 from the flexible tube 30 and near the lesioned part X. (See FIG. 6).
[0032]
Next, the flexible tube 30 is pulled out from the forceps channel, and instead, the grasping forceps 40 shown in FIG. 6 is inserted into the forceps channel, and the distal end portion thereof protrudes from the distal end surface 11 a of the insertion portion 11. The gripping forceps 40 includes a metal gripping member 41 that can be opened and closed at the distal end of the flexible tube 40a, and an operation portion (not shown) at the base end of the flexible tube 40a. Yes, when this operation unit is operated, the gripping member 41 opens and closes.
Then, the gripping forceps 41 is operated to grip the adjusting member 2f of the first clip 2, and the width thereof is narrowed, so that one of the lesioned portions X is between the two distal end portions 2b and 2d of the first clip 2. Grasp end X1 (see FIG. 6).
Further, by operating the grasping forceps 40 to grasp the adjusting member 3f of the second clip 3 and narrowing the width thereof, the other end of the lesioned part X (another target) between the two distal ends 3b and 3d. (Part) X2 is gripped (see FIG. 6).
[0033]
Next, the grasping forceps 40 is temporarily extracted from the endoscope 10, and the rubber band 4 is grasped by the grasping member 41 outside the body. In this state, the grasping forceps 40 is inserted into the forceps channel again, and the rubber band 4 and the insertion portion 11 are inserted. Is inserted into the organ B (see FIG. 6).
Then, by operating the operation part of the grasping forceps 40, a part of the rubber band 4 is passed between the engaging part 2a of the first clip 2 and the adjusting member 2f and engaged with the engaging part 2a. The other part of the rubber band 4 is engaged with the engaging portion 3a of the second clip 3 to complete the resection assisting device 1 in the organ B (see FIG. 7).
[0034]
Thus, when the resection assisting apparatus 1 is assembled with the first clip 2 and the second clip 3 hooked to the lesioned part X, the rubber band 4 extends compared to the initial state, and the first clip A tension that draws 2 and the second clip 3 close together is generated. For this reason, the 1st clip 2 is drawn near to the 2nd clip 3 side, and lesioned part X1 will be in the state pulled in the desired direction.
[0035]
Thus, when the lesioned part X is pulled in a desired direction, a sufficiently large excision part is formed at the boundary between the lesioned part X and the normal tissue. As shown in FIG. 7, an incision tool such as a high-frequency knife 50 is inserted into the organ B from the forceps channel and the lesioned part X is excised from the end X1 together with the mucous membrane.
Once the end portion X1 is excised, the lesioned portion X is moved to the end portion X2 side gripped by the second clip 3 from the end portion X1 portion gripped by the first clip 2 due to the tension generated in the rubber band 4. Since it is attracted, the excision area by the high-frequency knife 50 spreads smoothly from the end X1 side to the end X2 side (see FIG. 8), and eventually the entire lesioned part X is completely excised (see FIG. 9).
In the excision work with the high-frequency knife 50, the position of the tip 50a of the high-frequency knife 50 becomes easier to confirm as the excision area expands.
[0036]
When the excision work is completed as described above, the lesioned part X is attached to both the clips 2 and 3, so that the lesioned part X is prevented from being lost. In order to collect the excised lesion part X, the first clip 2, the second clip 3, the rubber band 4, and a part of the lesion part X, which are still connected, are grasped by the grasping forceps 40, and the endoscope Remove the mirror 10 from the body. After that, treatments such as suturing and disinfection of the excised part are performed.
[0037]
As described above, if the resection assisting apparatus 1 of the present embodiment is used, the lesioned part X can be moved in a desired direction by a sufficient distance without using an expensive apparatus such as a magnetic guidance apparatus. Therefore, the excision part of the boundary between the lesioned part X and the normal tissue can be secured easily and reliably with a sufficient size, and even if the lesioned part X has a flat shape, a sufficient size can be obtained. An excision portion can be created, and at the time of excision with a treatment instrument such as the high-frequency knife 50, one end X1 of the lesion X is pulled toward the other end X2 due to the tension of the rubber band 4, so the lesion X can be easily excised.
[0038]
Furthermore, since the lesioned part X is lifted by the first clip 2, a sufficient excised part can be secured, and the already excised lesioned part X can be prevented from falling on the proper muscle layer B2.
Moreover, since the 1st clip 2 and the 2nd clip 3 can be arrange | positioned in arbitrary positions, the visual field of an endoscope is not prevented by the excised lesioned part X. FIG.
[0039]
Next, a second embodiment of the present invention will be described with reference to FIGS.
The same members as those in the first embodiment are designated by the same reference numerals, and detailed description thereof is omitted.
[0040]
The resection assisting device 60 according to this embodiment includes a first clip 61, a second clip 62, and a compression coil spring 63 (traction connecting member) (elastic member).
The illustrated first clip ( first hooking member ) 61 is a member for grasping and lifting a lesion (target site) in a patient (target) body. The clip 61 is made of an elastic material bent into a U-shape, and includes a pair of opening / closing pieces 61a urged away from each other by the elasticity thereof. A tip portion 61b is formed. The relative distance between the two opening / closing pieces 61a is variable, and the both opening / closing pieces 61a are provided with a ratchet member 61c for fixing the position after adjusting the mutual distance. As shown in FIG. 11, the ratchet member 61c includes a pair of engaging pieces 61c1, and engaging teeth 61c2 that can be engaged and disengaged with each other are formed on the opposing surfaces of the engaging pieces 61c1. . The ratchet member 61c has a function of preventing the deformation when the pair of opening / closing pieces 61a is elastically deformed in the direction of reducing the distance and maintaining the distance after adjusting the distance between the opening / closing pieces 61a. Further, an engagement hole (engagement portion) 61d is formed between the base end portions of the both opening and closing pieces 61a.
[0041]
Similarly, a second clip ( second hooking member ) 62 shown in the figure has the same structure as the first clip 61, and includes an opening / closing piece 62a, a tip end portion 62b, a ratchet member 62c, and an engagement hole (engagement portion) 62d. And the lesioned part (target part) is grasped between the two end parts 62b.
[0042]
The compression coil spring 63 includes hook portions 63b and 63c at both ends of the spring portion 63a.
[0043]
Although illustration is omitted, the first clip 61 is grasped outside the body by the grasping member 41 of the grasping forceps 40, inserted into the organ B by the grasping forceps 40 in the state as it is, and the lesion is opened by opening the grasping member 41. Placed near the part X. The second clip 62 is also placed in the vicinity of the lesion X in the same manner.
Then, after thus placed with the first clip 61 second clip 62 in the vicinity of the lesion X, by tightening the ratchet member 61c of the first clip 61 by operating the grasping forceps 40, the first clip 61 Both the open / close pieces 61a are closed, and one end X1 of the lesion X is grasped by the both ends 61b (see FIG. 10).
Further, the other end X2 of the lesion X is grasped by the both ends 62b of the second clip 62 in the same manner.
[0044]
The compression coil spring 63 is inserted into the organ B by the grasping forceps 40 in the state where the hook portion 63b is grasped by the grasping member 41 of the grasping forceps 40 outside the body.
And after putting the grasping member 41 and the compression coil spring 63 into the organ B, the hook member 63b of the compression coil spring 63 is engaged with the engagement hole 61d of the first clip 61 by the grasping member 41, and thereafter The gripping member 41 pulls the hook portion 63c toward the second clip 62 against the urging force of the spring portion 63a, engages the hook portion 63c with the engagement hole 62d of the second clip 62, and resects the organ B. The auxiliary device 60 is assembled.
[0045]
Thus, when assembling the ablation auxiliary device 60 in a state in which the first clip 61 second clip 62 was hooked on the lesion X, the compression coil spring 63 is extended as compared to the initial state, the spring portion 63a, the An urging force that pulls the first clip 61 and the second clip 62 toward each other is generated. For this reason, the first clip 61 is drawn toward the second clip 62, and the lesion X1 is pulled in a desired direction.
[0046]
Therefore, according to this embodiment as well, a sufficiently large excision portion can be formed at the boundary between the lesion X and the normal tissue, and further, the lesion by using an incision tool such as the high-frequency knife 50. The entire X can be cut smoothly (not shown), and the same effect as in the first embodiment can be obtained.
[0047]
Finally, a third embodiment of the present invention will be described with reference to FIGS.
The same members as those in the first and second embodiments are designated by the same reference numerals, and detailed description thereof is omitted.
[0048]
The resection assisting device 70 of the present embodiment includes a first clip 61 and a second clip 62 having the same configuration as that of the second embodiment, and a string-like flexible connector 71 (traction connecting member).
The flexible connector 71 includes a string portion 71a that is flexible and has no elasticity, and four hook portions 71b, 71c, 71d, and 71e fixed to both ends and an intermediate portion of the string portion 71a. is there.
[0049]
The first clip 61 and the second clip 62 are inserted into the organ B in the same manner as in the second embodiment. Then, by using the gripping member 41, both end portions X1 and X2 of the lesioned portion X are gripped between the tip portions 61b and 62b of both the clips 61 and 62 (see FIG. 12).
[0050]
The flexible connector 71 is inserted into the organ B by the grasping forceps 40 in a state where the hook 71b is grasped by the grasping member 41 of the grasping forceps 40 outside the body.
Further, the hook member 71b at one end is engaged with the engagement hole 61d of the first clip 61 by the holding member 41, and then the hook portion 71e at the other end is further connected to the second clip by the holding member 41. The resection assisting device 70 is assembled in the organ B by being engaged with the engagement holes 62 d of 62.
Then, when the hook portion 71e is engaged with the engagement hole 62d, the string portion 71a is tensioned and tension T (see FIG. 12) is generated in the string portion 71a. Therefore, the first clip 61 is drawn toward the second clip 62 side. The lesioned part X1 is pulled in a desired direction. Therefore, according to this embodiment as well, a sufficiently large excision portion can be formed at the boundary between the lesion X and normal tissue, and the entire lesion X can be excised smoothly.
[0051]
Thereafter, when the hook portion 71e is removed from the engagement hole 62d by the grasping forceps (not shown) 40 and the hook portion 71d is engaged with the engagement hole 62d, a greater tension is generated in the string portion 71a . Since the clip 61 is further pulled toward the second clip 62 side, the excision force by the high-frequency knife 50 smoothly spreads from the one end X1 side of the lesion X1 to the other end X2 side. Further, as shown in FIG. 13, when the hook portion 71c is engaged with the engagement hole 62d using the grasping forceps 40, a larger tension is generated in the string portion 71a, and the first clip 61 is moved to the second clip 62 side. Therefore, the excision area further expands toward the end X2, and finally the lesion X is completely excised (not shown).
[0052]
As described above, according to the present embodiment, as in the first and second embodiments, a sufficiently large excision portion can be formed at the boundary portion between the lesion X and the normal tissue. The entire lesioned part X can be smoothly excised with an incision tool such as a scalpel 50.
[0053]
Furthermore, since the tension T generated in the string portion 71a is changed by selecting the hook portions 71c, 71d, 71e to be engaged with the engagement holes 62d of the second clip 62, the boundary portion between the lesioned portion X and the normal tissue It is possible to adjust the size of the excised portion to be formed.
[0054]
The present invention has been described above with reference to each embodiment. However, the present invention is not limited to the above-described embodiment, and can be improved or modified within the scope of the purpose of the improvement or the idea of the present invention. For example, instead of the first clips 2 and 61 and the second clips 3 and 62, fishhook-like needle members ( first hooking member and second hooking member ) (not shown) that can pierce the lesion X It is also possible to prepare two and connect these needle members with the rubber band 4, the compression coil spring 63, and the flexible connector 71.
[0055]
【The invention's effect】
As described above, according to the present invention, an endoscopic resection assisting device and a resection assisting device that are capable of pulling a lesioned part in a predetermined direction during resection, in a simple and reliable manner, and at a lower cost than in the past. It becomes possible to provide a treatment method using an endoscope.
[Brief description of the drawings]
FIG. 1 is a diagram showing a configuration of a resection assisting device according to a first embodiment of the present invention.
FIG. 2 is a diagram showing the shape of a clip.
FIG. 3 is a side view showing a state where a patient is placed on a bed.
FIG. 4 is an overall view of an endoscope used when excising a lesioned part.
FIG. 5 is a diagram showing a procedure for introducing a resection assisting device into an internal organ.
FIG. 6 is also a diagram showing a procedure for introducing a resection assisting device into an internal organ.
FIG. 7 is a diagram showing a lesion excision step using an excision assisting device.
FIG. 8 is a diagram similarly showing a lesion excision step using an excision assisting device.
FIG. 9 is a diagram showing a state in which a lesioned part is completely excised by excision of the lesioned part using the excision assisting device.
FIG. 10 is a diagram showing a lesion excision step similar to FIG. 7 of the second embodiment of the present invention.
FIG. 11 is an enlarged cross-sectional view of a ratchet member.
FIG. 12 is a view showing a lesion excision step similar to FIG. 7 of the third embodiment of the present invention.
FIG. 13 is also a diagram showing a lesion excision step.
[Explanation of symbols]
1 excision assisting device 2 first clip ( first hooking member )
2a engaging portion 2b tip portion 2c first base piece 2d tip portion 2e second base piece 2f adjusting member 3 second clip (second hooking member )
3a Engaging portion 3b Tip portion 3c First base piece 3d Tip portion 3e Second base piece 3f Adjustment member 4 Rubber band (traction connecting member) (elastic member)
5 Bed 10 Endoscope 11 Insertion portion 11a Tip surface 12 Air / water supply nozzle 13 Illumination window 14 Observation window 15 Forceps channel outlet 16 Forceps insertion port projection 16a Inlet 20 Overtube 30 Flexible tube 40 Grip forceps 40a Flexible Tube 41 Gripping member 50 High-frequency knife 50a Tip 60 Resection assisting device 61 First clip (first hooking member)
61a Opening / closing piece 61b Tip 61c Ratchet member 61c1 Engagement piece 61c2 Engagement tooth 61d Engagement hole (engagement part)
62 Second clip (second hooking member)
62a Open / close piece 62b Tip 62c Ratchet member 62c1 Engagement piece 62c2 Engagement tooth 62d Engagement hole (engagement part)
63 Compression coil spring (traction connecting member) (elastic member)
63a Spring part 63b 63c Hook part 70 Cutting assistance device 71 Flexible coupling tool (traction coupling member)
71a String part 71b 71c 71d 71e Hook part A Patient (object)
A1 head B organ B1 submucosa B2 proper muscle layer X lesion (target site)
X1 X2 end

Claims (8)

A first hooking member having a tip part for hooking a target part inside the object , and an engaging part formed at a position different from the tip part ;
A second hooking member having a tip part hooked inside the object at a position different from the first hooking member , and an engaging part formed at a position different from the tip part ;
Traction connecting member connecting the said engaging portion of the engaging portion and the second hooking member of said first hooking member, pulling the first hooking member in the second hooking member side,
An endoscopic resection assisting device comprising: The endoscopic resection assisting device according to claim 1, wherein the traction connecting member is an elastic member engaged with the first and second engaging members. The endoscopic resection assisting apparatus according to claim 2, wherein the elastic member is a rubber band engaged with the first and second engaging members . The endoscopic resection assisting device according to claim 2, wherein the elastic member is a compression coil spring having hook portions engaged with the first and second hooking members at both ends, respectively. An endoscopic resection assist device. The endoscopic resection assisting device according to claim 1, wherein the traction connecting member includes a flexible lace portion and at least three hook portions fixed to the lace portion in a longitudinal direction thereof, The endoscopic resection assisting device in which any two of the hook portions are selectively engaged with the first hooking member and the second hooking member , respectively. The endoscopic resection assisting device according to any one of claims 1 to 5, wherein at least one of the first hooking member and the second hooking member is openable and closable, and the clip can hold the target portion. Endoscopic resection aid device. The endoscopic resection assisting device according to any one of claims 1 to 6, wherein the first engaging member and the second engaging member have the same structure. The endoscopic resection assisting device according to any one of claims 1 to 7, wherein the traction connecting member is detachable with respect to the first and second hooking members. Resection aid.

Images