JPH04220245A - Cutter for excision of tissue - Google Patents

Abstract

PURPOSE:To provide the cutter for excision of the tissue which can remove the tissue of a cancer, etc., without making a surgical operation depending upon cases by forming this cutter so as to allow the safe and sure execution of the excision of the tissue of the stomach lesser curvature, gullet, etc., which are difficult to be excised by stripbiopsy. CONSTITUTION:A tube 1 consists of a main lumen 2 for inserting an endoscope and plural pieces of sub-lumens 7, 8 and is provided with a side hole 5, a cutter 15 for the inside surface and a balloon 6 of the outside peripheral surface in this order near the front end of the tube 1. The cutter 15 is joined to the front end of a lead wire 13, inserted into the sub-lumen 7 and slides forward and backward. This cutter is energized through the lead wire. The balloon 6 is expanded by feeding air thereto through the sub-lumen 8.

Description

[Detailed description of the invention]

0001

[Industrial Application Field] The present invention is easy to operate and is suitable for use in the diagnosis and treatment of cancer, which is one of the gastrointestinal diseases.
The present invention relates to a tissue resection cutter having a structure that allows safe and reliable cutting of tissues ranging from small ones to a wide range of tissues.

0002

[Prior Art] Tissues from the inner wall of the gastrointestinal tract can be collected by cutting them out under endoscopic observation using biopsy forceps or biopsy needles, or by hooking a snare on the tissue and cutting it out using high-frequency current, as in a strip biopsy. It is being done. However,
The former is a point-resected specimen, making it difficult to understand how far the disease has spread. In addition, the latter is superior to the former in terms of cutting out surface tissue, but it cannot be removed from the gastric incline or the wall of the esophagus unless it protrudes like a polyp, and the removal of this area is not recommended for the above-mentioned biopsy. It is difficult to use forceps or biopsy needles, and there are situations where it is impossible to diagnose by observation.

[0003] Furthermore, as it is not possible to make an effective diagnosis and there is no effective excision method for epithelial esophageal cancer, surgical treatment is performed, but the procedure itself is difficult because this area is close to the heart, etc. Therefore, depending on the patient's condition, radical treatment may not be possible and symptomatic treatment is required.

0004

[Problems to be Solved by the Invention] In view of the current situation in the diagnosis and treatment of cancers, including those of the digestive system, the present invention aims to treat tissues such as the gastric curvature and esophagus that are difficult to remove with strip biopsies. It is an object of the present invention to provide a tissue resection cutter that can safely and reliably perform resection and, depending on the case, can remove tissue such as cancer without performing a surgical operation.

[0005]

[Means for Solving the Problems] That is, the cutter for tissue resection according to the present invention is a tube consisting of a main lumen and a plurality of sublumens, and has a side hole near the distal end of the tube. An inflatable and deflated balloon is attached to the outer surface of the tube near the proximal side of the hole, and a sub-lumen for guiding the cutter opens at a position between the side hole and the balloon, and a sub-lumen opens at a position inside the balloon on the side wall of the tube. A balloon sub-lumen is provided, and
A slidable cutter is attached to the inner surface of the tube on the proximal side of the side hole, and a connector for connecting to a power source is provided at the rear end in the sublumen for guiding the cutter,
The tip side has a lead wire connected to the cutter,
Furthermore, a structural feature is that a branch pipe is provided at the rear end of the balloon sub-lumen.

Furthermore, at the proximal end of the tube,
The first feature is that an end cap is fitted with a slit or hole for inserting the endoscope into the main lumen, and a small hole for inserting the lead wire into the sub-lumen for guiding the cutter and providing sealing properties. 2.

[0007] The present invention will be explained in detail below based on the drawings. FIG. 1 is a plan view of a tissue resection cutter according to an embodiment of the present invention, FIG. 2 is a side cross-sectional view thereof, and FIG. 3 is A of FIG.
-A' and BB' sectional views.

The tube (1) is a main component constituting a main lumen (2) for mounting an endoscope, and has a handle (3) attached to its rear end. In the illustrated example, the tip of the main lumen (2) is open, but
It is not necessarily necessary to have an open structure. Also, the tube (
The proximal end of 7) is fitted and sealed with an end cap (4) made of a sealing membrane having a slit or hole of an appropriate size for inserting the endoscope. The material of this sealing membrane is not particularly limited, but it is preferably formed of a flexible sheet material such as rubber or thermoplastic resin.

A side hole (5) penetrating the main lumen (2) is provided in the tube wall located near the tip of the tube (1), and an air supply hole is provided on the outer surface of the tube near the proximal side of the side hole. A burl (6) that can be expanded and contracted by entering and exiting is installed.

[0010] Further, the side wall of the tube (1) is provided with a sub-lumen (7) for guiding the cutter and a sub-lumen (8) serving as a fluid passage for inflating and deflating the balloon, along the tube axis. There is. Of these, sublumen (7
) has a structure in which the tip opens near the side hole (5), and the rear end communicates with the proximal end of the tube (1), and the lead wire is usually inserted through the opening at the proximal end. It is said that

A slideable cutter (15) is provided on the inner surface of the tube at a position between the side hole (5) and the balloon (6).
) is connected to the tip of the lead wire (13) inserted into the tube (1).
a) As shown in FIG. 4(a), a guide notch (9) is provided to allow the cutter (15) to slide smoothly. The cutter (15) and the lead wire (13) may be connected not only in a completely fixed manner but also in a screw connection manner, which has the advantage that the cutter (15) can be easily replaced if it is damaged. Also, cutter (15)
A current is passed through the current-carrying connector (14) for ablation, but as shown in FIG. 4(b), the part is coated with a resin with excellent insulation so that the current is not applied to any part other than the part necessary for the ablation.

In FIG. 5, the cutter (15') is made all around in order to omit the induction notch, which not only eliminates the induction notch but also prevents distortion due to slight negative pressure in the tube (1). It's also holding.

The tip of the sub-lumen (8) for the balloon opens at a position inside the balloon (6) and connects to the lumen of the balloon (6), and the rear end opens into a branch pipe behind the handle (3). (10
) and connected to the air inlet (11). The structure of the air inlet (11) is preferably one that allows Luer fitting.
In addition, it is convenient to use a push-open type one-way valve.

FIG. 6 is a cutaway side sectional view showing the cutter for tissue resection according to the present invention in a state of use. First, the endoscope (16) is attached to the main lumen (2) of the tube (1), and its tip is inserted into the esophagus from the throat. In this state, maintain a slight negative pressure inside the tube (1) and move the endoscope (16)
While looking directly at the target esophageal cancer (18), insert it into the side hole (5).
). This capture can be carried out accurately and quickly without being affected by suction movement due to the side hole (5) installed in the tube wall and the action of suction.

When the target esophageal cancer (18) is captured in the side hole (5), the local injection needle (19) is inserted through the endoscope (16).
Puncture and inject saline through the connected tube up to the pre-planned resection area. after this,
The lead wire (13) is pushed to slide the cutter (15) through which a high-frequency current is applied, and the cutter (15) is pushed out to burn off the target esophageal cancer (18).

After the resection, the tube (1) is advanced to advance the balloon (6) to the resection site, and at that position, air is introduced from the air inlet (11) through the sub-lumen (8) for the balloon. By inflating the balloon (6), the targeted esophageal wall (18) is compressed to stop the bleeding.

[0017]

[Operation] The mucosal resection method using the tissue resection cutter of the present invention starts with a procedure in which an endoscope is attached in the main lumen, inserted into the digestive tract such as the esophagus or stomach, and the mucosal tissue is captured in a slightly reduced pressure state. will be started. At this time, the site where the target lesion exists can be seen directly with the endoscope by suctioning into the side hole installed near the tip of the tube, so it can be accurately viewed without being affected by respiratory movement. It is possible to capture

Next, physiological saline is injected through the endoscope using a local injection needle. By adjusting the injection volume, the amount of tissue captured can be adjusted. It also serves as a protective layer to prevent deep cuts when making wide cuts. After capture, a cutter running a high-frequency current is slid to cut out the mucosal tissue. After the treatment, the tube is moved to the resection site and the balloon is inflated and compressed to stop the bleeding. With such a structure, safe and reliable biopsy and resection operations can be performed at all times.

[0019]

[Effects of the Invention] As described above, by using the tissue resection cutter of the present invention, it is possible to accurately and quickly capture tissue at a target site with good operability even in narrow digestive tracts such as the esophagus and large intestine. The resection range can also be adjusted and resection can be performed easily. The processing time is short, and if the mucosal epithelium is to be removed, the treatment can be performed on an outpatient basis. Additionally, the tube can be made to have a small diameter, which reduces patient pain and speeds up medical procedures.

[0020] Therefore, biopsies and resections of mucous membranes can be performed with simple operation and excellent safety, resulting in industrial benefits that greatly contribute to the medical field.

[Brief explanation of the drawing]

FIG. 1 is a plan view of a tissue resection cutter according to an embodiment of the present invention.

FIG. 2 is a side sectional view of a tissue resection cutter according to an embodiment of the present invention.

3A and 3B are sectional views taken along line AA' and line BB' in FIG. 2, respectively;

FIG. 4 is a diagram showing the structure of the tube tip and cutter of the tissue resection cutter of the present invention.

FIG. 5 is a diagram showing an example of another shape of the cutter.

FIG. 6 is a diagram for explaining how to use the tissue resection cutter of the present invention.

Claims (2)

[Claims] Claim 1: A tube consisting of a main lumen and a plurality of sub-lumens, which has a side hole near its distal end, and an inflatable and deflated balloon on the outer surface of the tube near the proximal side of the side hole. A cutter guiding sub-lumen that opens at a position between the side hole and the balloon, and a balloon sub-lumen that opens at a position within the balloon are provided on the side wall of the tube, and
A slidable cutter is attached to the inner surface of the tube on the proximal side of the side hole, and a connector for connecting to a power source is provided at the rear end in the sublumen for guiding the cutter,
The tip side has a lead wire connected to the cutter,
Furthermore, the tissue resection cutter is characterized in that a branch pipe is provided at the rear end of the balloon sub-lumen. [Claim 2] A slit or hole for inserting an endoscope into the main lumen at the proximal end of the tube;
2. The tissue resection cutter according to claim 1, further comprising an end cap provided with a small hole for inserting a lead wire into the cutter guiding sub-lumen and providing sealing properties.