JP4767577B2 - Detainer - Google Patents

Description

  The present invention relates to an indwelling device that is placed in a body cavity during a surgical operation or the like.

In the surgical operation by laparoscope or laparotomy, there is a scoring method as a treatment for grasping a lesion part generated inside a luminal organ such as the stomach or the large intestine. The inking method is a few days to a few weeks before the operation, from the inside of the luminal organ, the ink that serves as a mark is injected into the living tissue where the lesion has occurred, and the position of the lesion is determined from the outside of the luminal organ. It is a treatment that facilitates direct or indirect identification with the naked eye. Specifically, an endoscope is inserted from the mouth, and ink is injected by inserting a needle into the organ wall located near the lesion from the inside of the luminal organ. The injected ink spreads along the wall, and assists in visually confirming the lesioned part at the time of excision.
At this time, it is necessary to keep in mind that the needle tip does not penetrate through the wall portion and is injected at a depth that allows the position of the tattoo to be visually recognized when the luminal organ is viewed from the outside. If the needle penetrates the wall, not only the lesion site is unclear, but many other organs may be covered with ink so that the operation cannot continue. Also, if the ink can not be injected so that it can be seen outside the stomach or large intestine, the lesion site cannot be identified, which may cause the lesion to be left behind. In short, the problem with this inking method is that it requires a high technique for adjusting the depth of needle insertion so as to ensure the inking.

  In view of this, a method has been proposed that makes it possible to accurately grasp a desired location of a luminal organ without performing high-quality inking in laparoscopic or open surgery. In this method, a magnetic substance is placed in advance at a predetermined position inside the lumen organ, and a magnetic flux density variable type forceps is brought close to the outside of the lumen organ at the time of surgery, and placed inside the lumen organ. The magnetic body is pulled together with the living body tissue of the luminal organ to the magnetic forceps (see Non-Patent Document 1 below). According to this method, when the magnetic forceps are brought close to the outside of the lumen organ in which the magnetic body is placed, the magnetic body is attracted to the magnetic forceps so that the wall portion of the lumen organ in which the magnetic body is placed rises outward. Transforms into Therefore, by visually recognizing the deformation from the outside of the luminal organ, the position where the magnetic body is placed can be easily grasped accurately in a short time.

In addition to attracting the magnetic material placed inside the lumen organ to the magnetic forceps together with the living tissue of the lumen organ, the magnetic material is adsorbed to the magnetic forceps together with the living tissue of the lumen organ, thereby It is possible to grasp a desired part of an organ accurately and without damaging a living tissue.
Japanese Society of Surgery, Vol. 105, Special Issue, March 15, 2004 “Abstracts of the 104th Annual Meeting of the Japanese Surgical Society”, p. 307, “Magnetic flux density variable type for lesion capture and intestinal resection under endoscopic surgery” Usefulness of magnetic forceps: Takeshi Ohira, Masami Masako, Hideo Nagai

In the method for exploring a luminal organ using a magnetic material as described above, when the magnetic material is placed at a predetermined position inside the luminal organ, the magnetic material is previously connected to an anchor such as a clip with a wire or the like. In addition, it is conceivable that the anchoring device connected with the magnetic body via the wire is anchored to the inner position of the lumen organ.
However, with such an indwelling method, the anchoring tool and the magnetic body, which are relatively small parts, must be connected with a wire or the like, and the connecting operation using the wire or the like is troublesome. In addition, these connected attachments and the like must be set in the channel of the endoscope, and the setting work thereof is troublesome because the channel diameter is small. In addition, since the magnetic body is set in the endoscope channel together with the attachment tool, only a relatively small magnetic body can be placed. Furthermore, since it connects with a wire etc., there existed a problem that an anchorage tool and a magnetic body had to be managed by a pair, and those management also became troublesome.

  The present invention has been made in view of the above circumstances, and there is no need to connect the anchoring tool and the magnetic body in advance, which can be easily assembled to the distal end of the endoscope, and a relatively large magnetic body. It is another object of the present invention to provide an indwelling device that can manage the anchoring device and the magnetic material separately.

As a means for solving the above problems, an indwelling device having the following configuration is employed.
That is, the indwelling device of the present invention is an indwelling device that is indwelled in a body cavity, and has a size that can be inserted into a channel provided in an insertion portion of an endoscope, A magnetic body detachably locked to a hood provided at a distal end of the insertion portion of the endoscope, and a magnetic body locked to the hood at the distal end of the insertion portion of the endoscope And a locking means for locking the magnetic body and the locking device when the locking device is relatively moved so as to approach each other.

  In the indwelling device of the present invention, the magnetic body is locked to the hood at the distal end of the insertion portion of the endoscope, and the anchoring device is set in the channel of the endoscope. In this state, the anchoring tool is moved to the distal end side of the channel. Then, the magnetic body and the anchoring tool are locked by the locking means. Thereafter, the magnetic body is detached from the hood at the distal end of the endoscope by further movement of the anchoring tool. Then, when the anchoring device is engaged with the living tissue, the magnetic body locked to the anchoring device via the locking means is simultaneously placed at a predetermined position of the living tissue. Further, since the magnetic body is locked not on the endoscope channel but on the tip hood, even a relatively large magnetic body can be set in the endoscope.

In the indwelling device of the present invention, the locking means includes a locking string provided on the magnetic body, and when the locking device is locked to the living tissue, the locking string is locked. It is preferable to be sandwiched between a tool and the living tissue.
In this case, when the magnetic body is locked to the hood at the distal end of the insertion portion of the endoscope, the locking string provided on the magnetic body is set so as to be positioned at the outlet portion of the channel. In this state, when the engaging tool protrudes from the channel, the engaging tool locks the locking string. When the locking tool is locked to the living tissue, the locking string is sandwiched between the locking tool and the living tissue.

In the indwelling device of the present invention, the engaging device includes a pair of clip claws that sandwich the living tissue, and a holding portion that holds the locking string is interposed between the pair of clip claws. It is preferable to be provided.
In this case, once the locking string is held in the holding portion between the pair of clip claws, for example, gravity acts on the magnetic body and the magnetic body is about to fall from the clip claw portion. However, the magnetic material does not fall. That is, it is possible to prevent the magnetic body from falling from the pair of clip claws even when the tips of the pair of clip claws are directed downward before the anchor is engaged with the living tissue.

In the indwelling device of the present invention, the magnetic body is provided with an engaging / disengaging portion that switches from the locked state to the released state each time the magnetic body is rotated relative to the hood by a predetermined angle. preferable.
In this case, after the magnetic body attached to the hood at the distal end of the endoscope is locked to the engagement tool via the locking string, the engagement of the magnetic body relative to the hood is performed by rotating the engagement tool. Can be rotated. Thereby, the magnetic body in a locked state with respect to the hood can be brought into a released state.

In the indwelling device of the present invention, the locking means includes a connection string formed in the magnetic body and passing through an insertion hole having a size through which the engagement tool can be inserted. It is preferable that it is composed of a rod member which is connected to a tool and which cannot be inserted into the insertion hole of the magnetic body after exiting from the insertion portion into the body cavity .
In this case, the anchoring tool connected to the rod member by the connecting string is inserted into the insertion hole of the magnetic body, and the engaging tool is engaged to the living tissue while the connecting string is passed through the insertion hole of the magnetic substance. . As a result, the magnetic body can move only between the living tissue to which the anchoring tool is attached and the bar member, and as a result, is left in the living tissue.

In the indwelling device of the present invention, the engaging device is made of a pantograph material that can be inserted into the locking insertion hole formed in the magnetic body when the diameter is reduced and cannot be inserted when the diameter is expanded. The locking means comprises a locking cylinder attached to the pantograph material, and on the outer periphery of the locking cylinder, when the locking cylinder is inserted into the locking insertion hole of the magnetic body, It is preferable that a fitting portion that is fitted to a convex portion or a concave portion formed on the inner periphery of the locking insertion hole is provided.
In this case, after passing the pantograph material in the reduced diameter state through the locking insertion hole formed in the magnetic body, if the pantograph material is further moved in the same direction, the locking cylinder attached to the pantograph material is fitted. The portion is fitted into the locking insertion hole of the magnetic body. Thereafter, the pantograph material is invaded into the living tissue, and the diameter is expanded in the living tissue. Thereby, the magnetic body can be placed at a predetermined position of the living tissue.

In the indwelling device of the present invention, it is preferable that the pantograph material is switched from the reduced diameter state to the enlarged diameter state by pulling the wire tied to the distal end portion toward the proximal end side.
In this case, after the pantograph material has entered the living tissue, the pantograph material can be switched from the reduced diameter state to the expanded diameter state by pulling a wire tied to the distal end portion of the pantograph material to the proximal end side. As described above, the living tissue can be placed by a simple operation by the pantograph material and the magnetic material fitted to the pantograph material via the locking cylinder.

  According to the present invention, the magnetic body can be placed in the living tissue without connecting the anchoring tool and the magnetic body in advance. In addition, since the magnetic body is locked not on the endoscope channel but on the tip hood, even a relatively large magnetic body can be set on the endoscope. Further, since it is not necessary to connect the anchoring tool and the magnetic body in advance, it is easy to assemble the anchoring tool and the magnetic body to the distal end of the endoscope, and they can be managed separately.

<First Embodiment>
A first embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 1, an indwelling tool 1 </ b> A of the present embodiment includes a magnet (magnetic body) 10, a clip (engagement tool) 11, and a wire (locking string) 12 that locks the magnet 10 and the clip 11. And. The clip 11 is made of metal. The wire 12 may be made of metal, but it is preferable that the wire 12 is made of resin, for example, so that it can be coped with when it is necessary to cut with a treatment tool for an endoscope.
The magnet 10 is formed in a ring shape. The outer diameter of the magnet 10 is set slightly smaller than the inner diameter of the cylindrical hood 5 attached to the distal end of the insertion portion 4 of the endoscope. The wire 12 is attached to the ring-shaped magnet 10 so as to extend in the radial direction.

  The clip 11 includes a tubular body 11a formed in a cylindrical shape and a pair of clip claws 11b inserted into the tubular body 11a and movable in the axial direction of the tubular body 11a. The outer diameter of the tubular body 11a is set smaller than the inner diameter of the channel 6 of the endoscope, and can be inserted into the channel 6. The pair of clip claws 11b are connected to each other at their proximal ends, and are actually made of a single spring material. The pair of clip claws 11b extend in an X shape from the proximal end to the distal end and intersect with each other. And the base end side of the cross | intersection part 11c is closed in the ring shape, and becomes the holding | maintenance part 11d which hold | maintains the said wire 12. FIG. The tips of the clip claw portions 11b are bent in directions approaching each other. Each member constituting the indwelling tool 1A is coated with silicon or titanium in order to eliminate the influence on the living body.

  The pair of clip claws 11b are open at the end protruding from the tube 11a, but when the tube 11a is operated so as to approach the tip of the clip claw 11b using the dedicated instrument 3. The tips of the pair of clip claws 11b approach each other. In order to fix the biological tissue to the clip 11, the pair of clip claws 11b are brought close to the biological tissue, the biological tissue is disposed between the clip claws 11b, and the tube body 11a is attached to the distal end side of the clip claws 11B. And the tips of the pair of clip claws 11b are moved closer to each other. Thereby, a biological tissue is inserted | pinched between a pair of clip nail | claw part 11b, and, as a result, the clip 11 is fixed to a biological tissue (refer FIG. 5).

  The hood 5 is provided with an enlarged diameter portion 5a on the proximal end side, and is fitted to the distal end of the insertion portion 4 of the endoscope by the enlarged diameter portion 5a. A plurality of projections 5b are formed on the hood 5 at predetermined positions on the inner surface with a circumferential interval. When the hood 5 is fitted to the distal end of the insertion portion 4 of the endoscope, a gap 5c is formed between the distal end of the insertion portion 4 of the endoscope and the projection 5b, and the magnet 10 is inserted into the gap 5c. Is locked. The hood 5 is made of an elastic material such as plastic. For example, when the magnet 10 locked in the gap 5c is pushed toward the distal end side of the hood 5 by the clip 11 or the like, the protrusion 5b is elastically deformed to be removed from the gap 5c.

A method for indwelling the indwelling device 1A configured as described above in the stomach of a patient using an endoscope will be described.
First, as shown in FIG. 1, the magnet 10 is set in a gap 5c between the distal end of the insertion portion 4 of the endoscope and the hood 5 attached thereto. At this time, the assembly angle of the magnet 10 is adjusted so that the wire 12 attached in advance to the magnet 10 is positioned at the opening portion of the channel 6 of the insertion portion 4 of the endoscope as shown in FIG. Further, the clip 11 and the instrument 3 for opening and closing the clip 11 are inserted into the sheath 2. Next, the sheath 2 with the clip 11 or the like set at the tip is set in the channel 6 of the insertion portion 4 of the endoscope. Subsequently, the sheath 2 is operated to be pushed into the distal end side of the channel 6, and the clip 11 is moved to the distal end of the insertion portion 4.

Next, the insertion portion 4 of the endoscope is inserted into the body from the patient's mouth. When the distal end of the insertion section 4 reaches the stomach, the clip 11 is moved together with the sheath 2 to the distal end side of the channel 6. Thereby, the clip 11 is pushed out from the opening portion of the channel 6 of the insertion portion of the endoscope, and the wire 12 attached to the magnet 10 is sandwiched between the tips of the pushed clip 11.
In this state, as shown in FIGS. 6 and 7, the instrument 3 and the sheath 2 are operated to rotate the clip 11 in a predetermined direction. At this time, the clip 11 is elastically deformed to open the intersecting portion 11c of the pair of clip claw portions 11b, and to invade the wire 12 into the holding portion 11d. Thereby, the wire 12 can be held by the holding portion 11 d of the clip 11.

  Next, the clip 11 is moved together with the sheath 2 to the distal end side of the hood 5 through the instrument 3. Accordingly, the magnet 10 is pushed and moved to the distal end side of the hood 5 through the clip 11 and the wire 12 locked to the clip. At this time, the protrusion 5b of the hood 5 is elastically deformed, and the movement of the magnet 10 toward the tip side of the hood 5 is allowed. That is, the magnet 10 is separated from the gap 5 c of the hood 5. The magnet 10 moves further forward (to the left in FIG. 1) while the wire 12 is locked by the clip 11 and comes out of the hood 5.

  Next, as shown in FIGS. 4 and 5, the lesion is visually recognized using an endoscope, and then the clip 11 is fixed to the inner wall of the stomach located in the vicinity thereof (the clip 11 is fixed). See above for the operating procedure to do). At this time, the positional relationship between the lesioned part and the place where the indwelling tool 1A, that is, the clip 11 is fixed is accurately grasped so that the lesioned part can be accurately excised at the time of surgery.

  When indwelling a plurality of indwelling devices 1A inside the stomach, the endoscope is once extracted outside the body, and the sheath 2 and the clip operating device 3 are extracted from the channel 6. Then, the magnet 10 is newly set on the hood 5, and the sheath 2 equipped with the clip 11 is inserted into the channel 6 from the proximal end side of the insertion portion 4 together with the clip operating device 3. Then, the same procedure as above is repeated to place the indwelling tool 1A in the stomach.

  According to the present invention, there is no need to connect the clip 11 and the magnet 10 in advance, and the magnet 10 can be placed in the living tissue. Moreover, since the magnet 10 is locked to the hood 5 at the tip instead of the channel 6 of the endoscope, a relatively large magnet 10 can be set on the endoscope. Further, since it is not necessary to connect the clip 11 and the magnet 10 in advance, the clip 11 and the magnet 10 can be easily assembled to the distal end of the endoscope, and the clip 11 and the magnet 10 are managed separately. can do.

  In this embodiment, when the magnet 10 is set on the hood 5, a plurality of protrusions 5 b provided on the inner periphery of the hood 5 are used. However, the present invention is not limited to this. A configuration as shown may be used.

  8 to 10, locking protrusions 20a are provided on the inner periphery of the hood 20 at predetermined angular intervals in the circumferential direction. In addition, on the outer periphery of the magnet 21, locking protrusions 21a and locking groove portions 21b are alternately provided in the circumferential direction so as to correspond to the locking protrusions 20a. Here, the locking protrusion 21a and the locking groove portion 21b of the magnet 21 constitute an engaging / disengaging portion that switches from the locked state to the released state when the magnet 21 is rotated relative to the hood 20 by a predetermined angle. .

  When the magnet 21 is set on the hood 20, the angle of the magnet 21 is adjusted so that the locking groove portion 21 b matches the locking projection 20 a when viewed from the front. In this state, the magnet 21 is placed at the back of the hood 20. Push in. Then, after the magnet is pushed deeper than the locking projection, the magnet 21 is rotated by a predetermined angle, and the locking projection 21a of the magnet 21 is seen from the front as shown in FIG. To overlap. Thus, the magnet 21 can be set on the hood 20 without dropping off.

  For example, in order to remove the magnet 21 from the hood 20 inside the stomach of the patient, the magnet 21 is rotated together with the clip in a predetermined direction while the wire 12 is locked by the clip. In this way, the locking groove 21b of the magnet 21 is matched with the locking projection 20a of the hood 20 when viewed from the front. In this state, the magnet 21 may be pushed and moved to the opening side of the hood 20 through the clip.

  In the above-described embodiment, the ring-shaped magnets 10 and 21 are used as the magnetic body placed in the body cavity. However, the present invention is not limited to this, and as shown in FIG. 25 may be used. In this case, as a locking means for locking the magnet 25 and the clip 11, for example, a locking string 26 attached so as to form a loop at one end of the columnar magnet 25 is used. When the columnar magnet 25 is set on the hood 5, a part of the loop of the locking string 26 is opened by the locking string holding portion (not shown) provided on the inner peripheral surface of the hood 5. Positioned to be located in the part.

Next, a second embodiment of the present invention will be described with reference to FIGS. In addition, the same code | symbol is attached | subjected to the component already demonstrated in said embodiment, and description is abbreviate | omitted.
As shown in FIG. 12, in the indwelling tool 1 </ b> B of the present embodiment, an insertion hole 31 parallel to the axial direction of the magnet is formed in the ring-shaped magnet 30 that is locked to the inner surface of the hood 5. The insertion hole 31 is formed at a position that matches the opening of the channel 6 of the endoscope when the magnet 30 is set at a normal position with respect to the hood 5. Further, the inner diameter of the insertion hole 31 is set to be approximately the same as the inner diameter of the channel 6 so that the clip 11 can be inserted.
Similarly to the insertion hole 31, the magnet 30 has an objective lens for taking an endoscope image into the imaging means (CCD) and a position corresponding to the light guide lens surface for irradiating observation light, respectively. Openings 30a and 30b are provided. Thereby, the magnet 30 to be described later can be placed under the same image as in normal endoscopic observation.
One end of a wire (connection string) 32 is connected to the clip 11, and the other end of the wire 32 is connected to a substantially central portion of a linear bar member 33 set to a predetermined length. The length of the wire 32 is set longer than the thickness of the magnet. Further, the rod member 33 is set to a value whose length is longer than the inner diameter of the insertion hole 31. Here, the wire 32 and the bar member 33 constitute locking means for locking the magnet 30 and the clip 11.

A method of placing the indwelling device 1B configured as described above in the stomach of a patient using an endoscope will be described.
First, as shown in FIG. 12, the magnet 30 is set in the gap between the distal end of the insertion portion 4 of the endoscope and the hood 5. At this time, the assembly angle of the magnet 30 is adjusted so that the insertion hole 31 of the magnet 30 matches the opening of the channel 6 of the endoscope. Further, the clip 11 and the instrument 3 for opening and closing the clip 11 are inserted into the sheath 2. Next, the sheath 2 with the clip 11 or the like set at the tip is set in the channel 6 of the insertion portion 4 of the endoscope. Subsequently, the sheath 2 is operated to be pushed into the distal end side of the channel 6, and the clip 11 is moved to the distal end of the insertion portion 4.

  Next, the insertion portion 4 of the endoscope is inserted into the body from the patient's mouth. When the distal end of the insertion portion reaches the stomach, the clip 11 is moved to the distal end side of the channel 6 together with the sheath 2. Thereby, the tip of the sheath 2 together with the clip 11 protrudes outward from the channel 6 and is inserted into the insertion hole 31 of the magnet 30. Here, a projection 2a (or a stepped portion) is provided in advance on the outer periphery of the sheath 2, and after the projection 2a is locked in the insertion hole 31, the magnet 30 together with the clip 11 and the sheath 2 And is pushed forward and comes out of the hood 5.

  Next, after visually recognizing the lesion using an endoscope, the clip 11 is fixed to the inner wall of the stomach located in the vicinity thereof. That is, as shown in FIG. 14, after the tips of the pair of clip claws 11b of the clip 11 are once opened and advanced to a position where the living tissue can be locked, the tips of the pair of clip claws are closed, The living tissue B is sandwiched. Thereafter, the clip operating instrument 3 and the sheath 2 are pulled into the channel 6 by releasing the engagement with the clip 11.

At this time, the clip 11 and the rod member 33 connected to the clip 11 via the wire 32 remain in the patient's body. That is, when the distal end side of the sheath 2 is drawn into the channel 6, the wire 32 and the rod member 33 come out of the sheath 2. Since the wire 32 is connected to the central portion of the rod member 33, when the rod member 33 comes out of the sheath 2 and enters a free state in which the posture is not regulated by the sheath 2, the rod member 33 has a form with an angle with respect to the wire 32. The magnet 30 cannot pass through the insertion hole 31 and cannot be inserted into the insertion hole 31.
Eventually, the magnet 30 can only move between the clip 11 and the bar member 33 and is left in the patient's body.

  When indwelling a plurality of indwelling devices 1B inside the stomach, the endoscope is once extracted outside the body, and the sheath 2 and the clip operating device 3 are extracted from the channel 6. Then, the magnet 30 is newly set on the hood 5, and the sheath 2 fitted with the new clip 11 is inserted into the channel 6 from the proximal end side of the insertion portion 4 together with the clip operating tool 3. Then, the same procedure as above is repeated to place the indwelling tool 1A in the stomach.

  According to the present invention, similarly to the first embodiment described above, it is not necessary to connect the clip 11 and the magnet 30 in advance, and the magnet 30 can be placed in the living tissue. Further, since the magnet 30 is locked to the hood 5 at the distal end rather than the channel 6 of the endoscope, even a relatively large magnet 30 can be set on the endoscope. Further, since there is no need to connect the clip 11 and the magnet 30 in advance, the clip 11 and the magnet 30 can be easily assembled to the endoscope tip, and the clip 11 and the magnet 30 are managed separately. can do.

  In the above-described embodiment, the straight bar member 33 is used to lock the clip 11 and the magnet 30. However, the present invention is not limited to this, and the configuration shown in FIG. Alternatively, the bar member 34 may be used.

The rod member 34 shown in FIG. 15 is formed by, for example, radially extending each branch portion 34b from a central core portion 34a, and at least each branch portion 34b is made of an elastic material such as plastic or a spring material. Yes. When the rod member 34 is set in the sheath 2, as shown in FIG. 15A, the branch portion 34b is folded like an umbrella. When the sheath 2 comes out, each branch part 34b expands by its own elastic action and cannot be inserted into the insertion hole 31 of the magnet 30.
Even if the bar member 34 having such a configuration is used, the clip 11 and the magnet 30 can be locked.

Next, a third embodiment of the present invention will be described with reference to FIGS. In addition, the same code | symbol is attached | subjected to the component already demonstrated in said embodiment, and description is abbreviate | omitted.
As shown in FIG. 16, in the indwelling device 1 </ b> C of the present embodiment, a pantograph material 40 is used as an anchoring device that is anchored to a living tissue. The pantograph member 40 can be inserted into the engagement insertion hole 42 formed in the ring-shaped magnet 41 engaged with the inner surface of the hood 5 when the diameter is reduced, and cannot be inserted when the diameter is increased. Is. As a specific configuration of the pantograph material 40, an L-shaped wire 40 a having a node at the center is bundled so that a plurality of (for example, three or four) each node faces outward, And the base end portion are connected to each other. Further, in the pantograph material 40, the wire 40b is tied to the distal end portion of the wire 40a, and when the wire 40b is pulled to the proximal end side, each wire 40a is bent from the node, resulting in a reduced diameter state. Switches to the expanded state.

  A locking cylinder 43 is attached to the base end of the pantograph material 40. A ring-shaped collar portion (fitting portion) 43 a is formed on the outer periphery of the central portion of the locking cylinder 43. When the locking cylinder 43 is inserted into the locking insertion hole 42 of the magnet 41, the collar portion 43a is fitted into a ring-shaped recess 42a formed on the inner periphery of the locking insertion hole 42, whereby the magnet 41. That is, the locking cylinder 43 constitutes locking means for locking the magnet 41 and the pantograph material 10.

A method for indwelling the indwelling device 1C configured as described above in the stomach of a patient using an endoscope will be described.
First, as shown in FIG. 16, a magnet 41 is set between the distal end of the insertion portion 4 of the endoscope and the hood 5. At this time, the magnet 41 is positioned so that the locking insertion hole 42 of the magnet 41 matches the opening of the channel 6 of the endoscope. Moreover, the pantograph material 40 and the instrument 3 for expanding the diameter of the pantograph material 40 via the wire 40 b are inserted into the sheath 2. Next, the sheath 2 is set in the channel 6 of the insertion portion 4 of the endoscope. Subsequently, the sheath 2 is operated to be pushed into the distal end side of the channel 6, and the pantograph material 40 is moved to the distal end of the insertion portion 4.

Next, the insertion portion 4 of the endoscope is inserted into the body from the patient's mouth. When the distal end of the insertion portion reaches the stomach, the instrument 3 for operating the pantograph material is operated to be pushed further into the channel 6. As a result, the distal end of the sheath 2 together with the pantograph material 40 protrudes outward from the channel 6. At this time, first, the pantograph material 40 is inserted into the locking insertion hole 42 of the magnet 41, and then the locking cylinder 43 is inserted into the locking insertion hole 42, but the collar portion 43 a of the locking cylinder 43 is When the ring-shaped recess 42a formed on the inner periphery of the locking insertion hole 42 is reached, the collar 43a and the ring-shaped recess 42a are fitted.
Thereafter, the magnet 41 fitted to the locking cylinder 43 is pushed forward together with the pantograph member 40 and the sheath 2 and comes out of the hood 5.

Next, after visually recognizing a lesion using an endoscope, the pantograph material 40 is fixed to the inner wall of the stomach located in the vicinity thereof. That is, as shown in FIG. 17, the pantograph material 40 is penetrated into the living tissue to a predetermined depth, and then the wire 40 b is drawn toward the proximal end side of the pantograph material 40. Thereby, the pantograph material 40 is switched from the reduced diameter state to the expanded diameter state, and is fixed in the living tissue.
As a result, the magnet is integrated with the pantograph member 40 via the locking cylinder 43 and is left in the patient's body. Thereafter, the pantograph material operating instrument 3 and the sheath 2 are pulled into the channel 6 by releasing the engagement with the pantograph material 40.

  When indwelling a plurality of indwelling devices 1C inside the stomach, the endoscope is once extracted outside the body, and the sheath 2 and the clip operating device 3 are extracted from the channel 6. Then, the magnet 41 is newly set on the hood 5, and the sheath 2 fitted with the new pantograph material 40 is inserted into the channel 6 from the proximal end side of the insertion portion 4 together with the instrument 3 for pantograph material diameter expansion operation. To do. Then, the same procedure as above is repeated to place the indwelling tool 1A in the stomach.

  According to this embodiment, similarly to the first and second embodiments described above, it is not necessary to connect the pantograph material 40 and the magnet 41 in advance, and the magnet 41 can be placed in the living tissue. Further, since the magnet 41 is locked to the hood 5 at the tip instead of the channel 6 of the endoscope, a relatively large magnet 41 can be set on the endoscope. Further, since there is no need to connect the pantograph material 40 and the magnet 41 in advance, the pantograph material 40 and the magnet 41 can be easily assembled to the distal end of the endoscope. Can be managed separately.

  In the illustrated example of the third embodiment described above, the magnet is placed in the living tissue using the pantograph material 40. However, when the fixing force of the pantograph material 40 is weak, FIG. 19 and FIG. The engaging force of the magnet 41 may be increased by the configuration as shown in FIG.

That is, in the structure shown in FIG. 19, a plate material 45 made of a magnetic material is embedded by a probe 44 in a living tissue to which the pantograph material 40 is to be fixed, and the magnet 41 is utilized by utilizing the adsorption force between the plate material 45 and the magnet 41. This increases the fixing force. As the plate member 45, for example, as shown in FIG. 20, a member whose tip is tapered and curved in the thickness direction so as to be easily inserted into a living tissue is used. The embedding of the plate material 45 into the living tissue may be performed simultaneously with the indwelling process of the pantograph material 40 or before the same process.
In the illustrated example of the third embodiment described above, the ring-shaped recess 42 a is provided on the inner surface of the locking insertion hole 42 of the magnet 41 and the collar portion 43 a is provided on the outer periphery of the locking cylinder 43. In addition, a collar portion may be provided on the inner surface of the locking insertion hole of the magnet 41, and a ring-shaped recess may be provided on the outer periphery of the locking cylinder 43.

In each of the above embodiments, the process of placing the indwelling device inside the stomach has been described. However, the place where the indwelling device can be placed includes any luminal organ other than the stomach. For example, an indwelling device can be placed inside the large intestine. In that case, the endoscope is inserted from the anus.
In each embodiment, a magnet having its own magnetic force is used as a magnetic body to be placed in the body. However, if the magnetic forceps emits a strong magnetic force, the magnet is placed on the magnetic body to be placed in the body. It is not necessary to use a metal material, and it is sufficient to use a metal material that is attracted to the magnet when a magnetic force acts.

  As mentioned above, although preferable embodiment of this invention was described, this invention is not limited to said embodiment. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit of the present invention. The present invention is not limited by the above description, but only by the scope of the appended claims.

It is a perspective view which shows 1st Embodiment of the indwelling tool of this invention. It is a perspective view of the indwelling tool of 1st Embodiment. It is a front view of the indwelling tool of 1st Embodiment. It is a perspective view explaining the indwelling method of the indwelling tool of 1st Embodiment. It is a perspective view explaining the indwelling method of the indwelling tool of 1st Embodiment. It is a perspective view explaining the indwelling method of the indwelling tool of 1st Embodiment. It is a perspective view explaining the indwelling method of the indwelling tool of 1st Embodiment. It is sectional drawing explaining the modification of the indwelling tool of 1st Embodiment. It is a perspective view explaining the modification of the indwelling tool of 1st Embodiment. It is a front view explaining the modification of the indwelling tool of 1st Embodiment. It is a perspective view explaining the modification of the indwelling tool of 1st Embodiment. It is a perspective view which shows 2nd Embodiment of the indwelling tool of this invention. It is a perspective view explaining the indwelling method of the indwelling tool of 2nd Embodiment. It is a perspective view explaining the indwelling method of the indwelling tool of 2nd Embodiment. (A), (b) is a perspective view which shows the modification of the indwelling tool of 2nd Embodiment. It is a perspective view which shows 3rd Embodiment of the indwelling tool of this invention. It is a perspective view explaining the indwelling method of the indwelling tool of 3rd Embodiment. It is a perspective view explaining the indwelling method of the indwelling tool of 3rd Embodiment. It is a perspective view which shows the modification of the indwelling tool of 3rd Embodiment. The modification of the indwelling tool of 3rd Embodiment is shown, (a) is a front view of a board | plate material, (b) is a side view.

Explanation of symbols

1A: Indwelling tool, 3: Instrument, 4: Insertion part, 5: Hood, 10: Magnet (magnetic body), 11: Clip (engaging tool), 11b: Clip claw part, 11d: Holding part, 12: Wire ( Locking string), 1B: detainer, 21: magnet (magnetic body), 21a: locking protrusion (engagement / disengagement part), 21b: engagement groove (engagement / removal part), 1B: detention tool, 30: magnet (magnetic) Body), 31: insertion hole, 32: wire (connection string), 33: bar member, 34: bar member, 1C: detainer 40: pantograph material, 41: magnet (magnetic body), 42: locking insertion hole, 43: Locking cylinder. 43a: collar part (fitting part)

Claims (7)

An indwelling device placed in a body cavity,
An anchor that is attached to a living tissue in a size that can be inserted into a channel provided in an insertion portion of the endoscope;
A magnetic body detachably locked to a hood provided at the distal end of the insertion portion of the endoscope;
When the engaging member moves relative to the magnetic body locked to the hood at the distal end of the insertion portion of the endoscope, the magnetic body and the engaging member are engaged. An indwelling device comprising locking means for stopping. The locking means comprises a locking string provided on the magnetic body,
The indwelling device according to claim 1, wherein when the anchoring device is anchored to the living tissue, the locking string is sandwiched between the anchoring device and the living tissue. The anchoring device comprises a pair of clip claws that sandwich the living tissue,
The indwelling device according to claim 2, wherein a holding portion that holds the locking string is provided between the pair of clip claws.   3. The magnetic body is provided with an engaging / disengaging portion that switches from a locked state to a released state when the magnetic body is rotated relative to the hood by a predetermined angle. Detainer. The locking means is
A connecting string that is formed in the magnetic body and that is passed through an insertion hole having a size that allows the engagement tool to be inserted;
A bar member that is connected to the anchoring device by the connecting string and that cannot be inserted into the insertion hole of the magnetic body after coming out of the insertion portion into the body cavity. Item 2. The indwelling device according to item 1. The engaging tool is made of a pantograph material that can be inserted when the diameter is reduced and cannot be inserted when the diameter is expanded, with respect to the locking insertion hole formed in the magnetic body,
The locking means comprises a locking cylinder attached to the pantograph material,
When the locking cylinder is inserted into the locking insertion hole of the magnetic body, an outer periphery of the locking cylinder is fitted with a convex portion or a concave portion formed on the inner periphery of the locking insertion hole. The indwelling device according to claim 1, wherein a joint portion is provided.   The indwelling device according to claim 6, wherein the pantograph material is switched from a reduced diameter state to an expanded diameter state by pulling a wire tied to a distal end portion toward a proximal end side.

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