JP2005007161A - EMR treatment tool and EMR device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an EMR treatment tool and an EMR apparatus for excising a lesion while reducing complications and burden on a patient in endoscopic mucosal resection.
SOLUTION: A peeling bulging member 110 is provided, and the separated portion 5a including the lesioned portion 4 and the non-affected portion 2b are separated and separated by the peeling bulging member so that the lesioned portion is raised. did. Therefore, the EMR treatment tool 100 and the EMR device 150 can perform endoscopic mucosal resection more easily than before, greatly reducing the operation time and improving the safety of the operation compared to the conventional. And the burden on the patient can be reduced.
[Selection] Figure 1

Description

  The present invention relates to an EMR treatment tool used for EMR (Endoscopic Mucosal Resection), that is, endoscopic mucosal resection, and an EMR device including the EMR treatment tool.

In recent years, a tube 11 is inserted into a body cavity using an endoscope 10 as shown in FIG. An endoscopic mucosal resection is performed in which a so-called high-frequency knife or the like, which is a kind of electric knife, is inserted and the lesion is removed with the high-frequency knife or the like. In such endoscopic mucosal resection, conventionally, as shown in FIG. 29, physiological saline, 5% sugar solution, epinephrine lyseol is applied to the submucosa 2 existing under the mucosa layer 5 where the lesion 4 is present. After injecting a solution or a drug such as 0.5% hyaluronic acid to raise the mucosal layer 5 and the submucosa 2 including the lesioned part 4, the lesioned part 4 is removed from the side of the raised part with the high-frequency knife 6 or the like. The connective tissue 7a of the submucosal layer 2 and the submucosal layer 2 and the submucosal layer 2 existing in the drug injection portion 7 are excised (for example, see Patent Document 1). In FIG. 29, 1 is a living body cavity, 1a is inside the body cavity, 1b is outside the body cavity, 3 is muscle tissue, 6 is a high-frequency knife and the like.
JP 2001-192336 A

  However, in the conventional method described above, the injected drug is easily absorbed by the submucosa 2 and the bulge is easily lost. Furthermore, the injected drug may flow out of the mucosa when the incision of the mucosa layer 5 and the submucosa 2 starts, and the above-mentioned bulge may be lost. Therefore, the distance between the submucosa 2 and the muscle tissue 3 below it may be lost. May not be maintained sufficiently, and may be perforated at the time of incision, and the lesioned part 4 may be left behind. In addition, due to the disappearance of the drug as described above, it is necessary to raise the lesioned part 4 several times during the operation. In the second and subsequent ridge-starting operations, the drug is injected into the same layer in the submucosa 2 as before. Since it is difficult to raise the layer and often it is raised from a deeper layer, as shown in FIG. 29, there is a possibility that complications such as perforation and bleeding, and the lesion 4 may be left behind. is there.

Furthermore, since there is a photographing lens at the distal end portion of the endoscope, in order to facilitate visual recognition and treatment of the lesioned part 4, the distal end portion of the endoscope is moved as shown by a virtual line in FIG. It is ideal to dispose the mucosa layer 5 and the submucosa 2 including the lesion part 4 from above by disposing them above the lesion part 4. However, in the conventional drug injection method, since the connective tissue 7a connecting the upper and lower sides of the drug injection portion 7 remains in the drug injection portion 7, the lesioned portion 4 is included while cutting the connective tissue 7a. It is necessary to excise the mucosa layer 5 and the submucosa 2. Therefore, as described above, conventionally, the mucosal layer 5 and the submucosa 2 including the lesioned part 4 must be excised from the side of the raised portion, and the distal end portion of the endoscope is raised as shown by the solid line in FIG. It is arranged on the side. In this way, when the distal end portion of the endoscope is arranged on the side surface of the raised portion, it is often difficult to visually recognize the lesioned portion 4. Therefore, there are cases where complications such as perforation and bleeding as described above and leaving of the lesioned part 4 occur due to the difficulty in visual recognition.
The present invention has been made in order to solve such problems. In endoscopic mucosal resection, a treatment tool for EMR that resects a lesion while reducing complications and burden on a patient, and It aims at providing the EMR apparatus provided with this treatment tool for EMR.

In order to achieve the above object, the present invention is configured as follows.
That is, the treatment device for EMR according to the first aspect of the present invention is inserted into a living body cavity through an endoscope, and then inserted into a submucosal layer located below a lesioned part existing in a mucosal layer of the body cavity. An exfoliating bulging member that exfoliates and separates the separated part where the part exists and the non-affected part that does not have the lesioned part under the separated part, and raises the lesioned part,
A first introductory member connected to the distal end portion for supporting the insertion of the exfoliating bulge member into the submucosal layer;
It is provided with.

  The exfoliation bulging member has a bag-like shape, is made of a material that expands with a gas or liquid supplied through the first introduction member, and has a size that bulges the lesioned part by the expansion. It can also comprise so that it may have.

  The exfoliation bulge member can also be made of a heat-resistant material that can withstand the heat generated when the bulged lesion is excised.

  Moreover, it can also comprise so that the removal | desorption mechanism which detaches | leaves the said 1st introduction member from the said peeling protrusion member may be comprised, maintaining the protruding state of the said lesioned part by the said peeling protrusion member.

Further, it is a member for facilitating the insertion of the exfoliation bulging member into the submucosal layer, and does not have the separated portion inserted into the submucosal layer and the lesioned portion existing therein and the lesioned portion under the separated portion. An insertion member that forms an injection part into which the non-affected part is separated and the exfoliation bulging member is inserted;
The insertion member may be further provided with a second introduction member provided at a distal end portion and supporting insertion of the insertion member into the submucosal layer.

  In addition, the insertion member may be formed integrally with the peeling protrusion member, and the first introduction member and the second introduction member may be formed integrally.

Furthermore, an EMR apparatus according to a second aspect of the present invention is the EMR treatment instrument according to the first aspect and an endoscope that is inserted from outside the living body into a living body cavity, and the EMR treatment instrument is inserted through the EMR apparatus. An endoscope for guiding an EMR treatment tool into the living body cavity;
It is provided with.

  Further, in the second aspect, the support member for the exfoliation bulging member that constitutes the EMR treatment instrument and bulges the lesion existing in the mucosal layer of the living body cavity, and to the exfoliation bulging member An expansion tool that is connected to a first introduction member for injecting gas or liquid outside the living body and expands the exfoliation bulging member to bulge the lesioned part may be provided.

In the second aspect, the EMR treatment tool is a member for facilitating insertion of the exfoliation bulging member into the submucosal layer, and a portion to be separated that is inserted into the submucosal layer and has the lesioned part. Further comprising an insertion member for separating an unaffected portion having no lesion under the portion to be separated and forming an injection portion into which the exfoliation bulging member is inserted;
The introduction member constituting the treatment device for EMR, which is a support member for exfoliating and raising the lesion existing in the mucosal layer of the living body cavity, and injecting gas or liquid into the exfoliation and elevation member 1 connected to the introduction member ex vivo, expands the exfoliation protuberance member to elevate the lesion, and constitutes the EMR treatment instrument, and supports the insertion member; You may comprise further the expansion | swelling tool connected with the 2nd introduction member which inject | pours the gas or the liquid to this member for insertion ex vivo, and expands the said member for insertion.

As described above in detail, according to the EMR treatment tool of the first aspect of the present invention and the EMR apparatus of the second aspect, the separation target includes a separation bulge member, and the separation ridge member includes a lesion portion. The part and the non-affected part having no lesion were separated and separated, and the lesion was further raised. Therefore, the disappearance of the bulge with the start of incision of the mucosal layer as in the prior art does not occur in the treatment tool for EMR and the EMR device, and thus it is not necessary to raise the affected part multiple times. In the EMR treatment tool and the EMR device, there is almost no possibility of complications such as perforation and bleeding, and the possibility of leaving the lesioned part. Therefore, the above-mentioned EMR treatment tool and EMR apparatus can perform endoscopic mucosal resection more easily and safely than conventional methods, and can significantly reduce the operation time compared to conventional methods. Can be reduced.
In addition, since the peeling bulging member has an action of peeling and separating, a wide range of peeling and incision using, for example, a high-frequency knife is performed in order to previously form a portion where the peeling bulging member is inserted in the submucosal layer. There is no need to do it. Therefore, it is possible to eliminate dangers such as perforation, bleeding, and leaving of a lesion part associated with the incision operation.

  As described above, when peeling and separating the part to be separated and the non-affected part with the peeling bulging member, a large peeling bulging member is inserted once into the submucosal layer located below the lesioned part. May be difficult. Therefore, before performing the ridge activation operation, using the insertion member that facilitates insertion of the exfoliation bulging member into the submucosal layer, the part to be separated and the non-affected part in advance for a part of the submucosal layer By separating and separating and forming an injection portion of the peeling bulging member, the peeling bulging member can be easily inserted and raised. This facilitates the procedure and further eliminates dangers such as perforation, bleeding, and leaving behind a lesion.

  An EMR treatment instrument and an EMR apparatus according to an embodiment of the present invention will be described below with reference to the drawings. In addition, in each figure, the same code | symbol is attached | subjected about the same component. In the present specification, an endoscope refers to a general instrument for diagnosing and treating a lesion in a body cavity by directly observing it with the naked eye or an image.

FIG. 1 shows a treatment tool 100 for EMR (Endoscopic Mucosal Resection) according to the present embodiment. The treatment tool 100 for EMR, in this embodiment, includes a peeling bulge member 110 and The first introduction member 120 is provided. The exfoliation bulging member 110 is also called an EMR balloon, and passes through the forceps channel 12 shown in FIG. 5 provided in the endoscope 10 as shown in FIG. 16 into a living body cavity such as the stomach, large intestine, small intestine, and esophagus. After being inserted, it is inserted into the submucosal layer 2 below the lesioned part 4 existing in the mucosa layer 5 of the body cavity, and a separated part 5a including the mucous membrane layer 5 where the lesioned part 4 exists, and under the separated part 5a A member that exfoliates and separates the unaffected portion 2b in the submucosal layer 2 that does not have the lesioned portion 4 and raises the separated portion 5a including the lesioned portion 4, and the tip portion of the first introduction member 120 121 is connected.
The part to be separated 5a is a concept including both the case of only the mucosal layer 5 or the case of up to the upper layer part of the submucosal layer 2 in the vicinity of the boundary between the mucosal layer 5 and the mucosal layer 5. Further, reference numeral 13 shown in FIG. 5 indicates a lens for imaging the body cavity, and reference numeral 14 indicates the illumination unit for imaging.
Further, as shown in FIG. 2, the peeling bulging member 110 can be attached to the first introduction member 120 so as to sandwich the tip portion 121 of the first introduction member 120.

  Such a peeling bulging member 110 has, for example, a bag-like shape, is made of an elastic material that can expand and contract, such as a rubber material, and is made of gas or liquid supplied through the first introduction member 120. It swells, performs the above-described separation and separation, and further raises at least the lesioned part 4. As will be described later, the lesioned part 4 raised by the exfoliation raising member 110 is excised with a high-frequency knife or the like together with the mucosal layer 5 around the lesioned part 4 or part of the mucosal layer 5 and the submucosal layer 2. Therefore, the peeling bulging member 110 is preferably made of a material having heat resistance and durability that can withstand damage due to heat, sparks, needles, and the like at the time of excision, such as silicon rubber, natural rubber, It is preferably made of a rubber material such as synthetic rubber, a styrene or urethane elastomer material, a thermoplastic material such as polyethylene or polypropylene, or vinyl chloride. Further, the thickness of the peeling bulge member 110 is uniform over the entire length, unlike the insertion member 130 described later, and can be a thickness greater than the maximum thickness of the insertion member 130. Further, since the exfoliation bulging member 110 is required to bulge at least the lesioned part 4 and further a part of the mucosal layer 5 and the submucosal layer 2 including the peripheral part of the lesioned part 4, The size of the member 110 needs to prepare a size corresponding to the size of the lesioned part 4, but is at least a size for raising the lesioned part 4. As an example, it has a substantially circular shape with a diameter of about 50 mm at the time of expansion, and the total height (thickness) of the peeling bulge member 110 at the time of expansion is about 5 to 10 mm. The shape of the exfoliation bulging member 110 at the time of expansion is not limited to the above-described substantially circular shape, and is a shape corresponding to the lesioned part 4. For example, an elliptical shape shown in FIG. 17A, a semicircular shape shown in FIG. 17B, or an arc shape shown in FIG. 17C can be considered.

  The first introduction member 120 is a tubular member having a diameter d of about 1.8 mm and a length of about 2 m so that the first introduction member 120 can pass through the forceps channel 12 of the endoscope 10. The peeling bulging member 110 is connected so that gas or liquid can be injected into the bag-like peeling bulging member 110 through the first introduction member 120. The peeling and bulging member 110 may be disposed outside the tip portion of the first introduction member 120 in a contracted state with respect to the first introduction member 120, or inside the first introduction member 120 at the tip portion. It may be arranged. The gas to be injected is, for example, air, and the liquid is, for example, water, physiological saline, a gel-like drug, or the like. In addition, as described above, since it is necessary to pass through the forceps channel 12 of the endoscope 10 and to further insert the peeling and bulging member 110 into the submucosal layer 2 below the lesioned part 4, the first introduction member In order to support 120, the first introduction member 120 is formed of a material having an appropriate hardness, or a guide member 122 having an appropriate hardness such as a piano wire is embedded or laid in the first introduction member 120. It can also be configured to. Further, as shown in FIG. 13, a guide member 122 may be provided in the first introduction member 120.

  Furthermore, the first introduction member 120 and the peeling and bulging member 110 can have a detachable structure. That is, after the peeling and bulging member 110 is inflated in the submucosal layer 2, the peeling and bulging member 110 is left in the mucosal layer 2 in an expanded state, and the first introduction member 120 is removed from the peeling and bulging member 110. It is possible to remove the first introduction member 120 from the body cavity to the outside of the patient. In this case, in order to maintain the expanded state of the separation / bulging member 110, for example, the separation / bulging member 110 is provided with a desorption mechanism 115 as shown in FIG. As an example of the detachment mechanism 115, as shown in FIGS. 3 and 4, simultaneously with the detachment of the first introduction member 120 from the separation bulge member 110, the introduction member insertion port 111 of the separation bulge member 110 is closed. A check valve structure can be adopted. The desorption mechanism 115 is not limited to the check valve structure. For example, the separation raising member 110 is maintained with the expansion state maintained by twisting the first introduction member 120 with respect to the separation raising member 110. The structure etc. which can isolate | separate the 1st introduction member 120 from this can be considered. Further, the detaching mechanism 115 can be provided not on the peeling bulging member 110 but on the first introduction member 120, or on both the peeling bulging member 110 and the first introduction member 120.

  Further, as described above, the distal end portion of the first introduction member 120 and the peeling bulging member 110 need to be inserted into the submucosal layer 2, but if the distal end portion of the first introduction member 120 has a pointed shape, When inserted into the submucosa 2, the straightness of the distal end portion of the first introduction member 120 becomes strong, and the exfoliation and bulging member 110 reaches the muscular tissue 3 or the body cavity outside 1 b below the submucosa 2 with excessive force. There is a possibility that. Therefore, even when the distal end portion of the first introduction member 120 is inserted obliquely toward the muscle tissue 3, the straightness of the distal end portion of the first introduction member 120 is weak and does not reach the muscle tissue 3. It is preferable that the first introductory member 120 and the peeling and bulging member 110 are formed in a weakly rectilinear shape in the submucosa 2. As an example of the weakly straight shape, for example, a spatula shape as shown in FIG. 14 is conceivable. FIG. 14 shows a form in which the peeling and protruding member 110 is disposed in the first introduction member 120.

  Next, as shown in FIG. 9, the EMR apparatus 150 of the present embodiment includes the above-described EMR treatment tool 100 and the EMR treatment tool 100 inserted into the body cavity 1 of the patient body 51. And an endoscope 10 for guiding to the center. Further, among the first introduction members 120 provided in the EMR treatment instrument 100 inserted into the endoscope 10, the rear end portion 123 located outside the patient's body 52 and extending outside the endoscope has a front end portion 121. An expansion tool 151 for supplying the gas or the liquid to the peeling bulging member 110 attached to the bulging member to expand the peeling bulging member 110 is connected. As the inflation tool 151, a syringe barrel as illustrated is convenient, but is not limited to a syringe barrel.

A method of using the EMR treatment tool 100 and the EMR device 150 configured as described above, that is, endoscopic mucosal resection performed using the EMR treatment tool 100 and the EMR device 150 will be described below.
First, with respect to the lesioned part 4 existing in the mucosal layer 5 of the living body cavity 1 shown in FIG. 6, as shown in FIG. 7, a puncture injection needle or the like is placed under the lesioned part 4 through the endoscope 10. 2 is inserted into the separation position 2a, for example, physiological saline is injected. This is for facilitating the insertion into the submucosa 2 below the lesioned portion of the exfoliation bulging member 110 described later. The separation position 2a is an arbitrary position in the thickness direction of the submucosa layer 2, the uppermost position is a boundary portion 5b between the mucosa layer 5 and the submucosa layer 2, and the lowermost position is the submucosa layer 2 and muscle tissue. 3 is a boundary portion 3a.

Next, after making a small hole reaching the submucosa 2 through the endoscope 10 with a high-frequency knife or the like, as shown in FIGS. 8 and 9, the EMR treatment tool 100 is endoscopeed. 10 is inserted into the forceps channel 12, and the peeling bulging member 110 is inserted through the small hole into the injection portion 2 c into which physiological saline or the like has been previously injected.
Next, as shown in FIG. 9, using the inflation tool 151 connected to the rear end portion 123 located outside the patient body 52 in the first introduction member 120 of the EMR treatment tool 100, the gas or The liquid is supplied to the peeling and bulging member 110 through the first introduction member 120. As a result, the exfoliation and bulging member 110 swells, the mucosal layer 5 where the lesioned part 4 exists or the part to be separated 5a including part of the mucosal layer 5 and the submucosal layer 2 and the lesioned part under the part to be separated 5a The non-affected part 2b having no 4 is separated and separated in the submucosa 2 and at least the lesioned part 4 is raised. The height to be raised here, that is, the height H from the surface of the mucous membrane layer 5 of the non-raised portion to the surface of the mucosal layer 5 of the raised portion is, for example, about 5 mm.
As described above, the separation bulging member 110 is inflated in the submucosal layer 2 to separate and separate the separated portion 5a and the non-affected portion 2b. Therefore, in the separation portion of the submucosal layer 2 described with reference to FIG. The connective tissue 7 a is cut by the expansion of the exfoliating and protruding member 110. Therefore, it is not necessary to cut the connective tissue 7a at the time of treatment as in the prior art.

  Next, as conceptually shown in FIG. 12, a high-frequency knife 53 or the like inserted through the endoscope 10 along the excision location 42 in the peripheral portion of the lesioned portion 4 among the protruding portions 41. The part to be separated 5a including the lesioned part 4 is excised. At this time, the heat due to the excision acts on the peeling bulging member 110, but the peeling bulging member 110 is not damaged by the heat resistance of the peeling bulging member 110. Therefore, the raised state of the lesioned part 4 is not lost during the treatment. In the excision, scissors forceps 161 as shown in FIG. 18 may be used instead of the high-frequency knife 53 or the like, or together with the high-frequency knife 53 or the like.

Further, when the above-described detachment mechanism 115 is provided on at least one of the peeling bulge member 110 and the first introduction member 120, the first introduction member 120 is detached from the separation bulge member 110 as shown in FIG. 1 The introduction member 120 can be extracted to the patient exterior 52. Then, the mucous membrane of the portion to be separated 5 a including the lesioned part 4 is excised along the excision location 42 with at least one of the high-frequency knife 53 and the scissors forceps 161.
In any case, the part to be separated 5a that has been excised is extracted together with the endoscope 10 to the outside of the patient 52, including the exfoliation bulging member 110 and the first introduction member 120. Further, when the first introduction member 120 is first taken out to the patient exterior 52, after the affected part is excised, the exfoliation bulging member 110 is contracted and taken out together with the endoscope 10 to the patient exterior 52.
This completes the endoscopic mucosal resection.

On the other hand, when the above-described detachment mechanism 115 is not provided on the separation / bulging member 110 and the first introduction member 120, the rear end portion 123 of the first introduction member 120 outside the patient body is closed to close the inside of the submucosa 2. The expanded state of the peeling bulge member 110 is maintained. Then, the endoscope 10 is once taken out of the patient body and the first introduction member 120 is removed from the endoscope 10 with the peeling / bulging member 110 and the first introduction member 120 inserted into the patient's body. Thereafter, the endoscope 10 is inserted again into the patient, and at least one of the high-frequency knife 53 and the scissors forceps 161 is inserted into the vacant forceps channel 12, and the portion to be separated 5a is excised as described above.
After the portion to be separated 5a is excised, the excised portion to be separated 5a and the endoscope 10 are extracted from the body cavity 1 to the outside of the patient 52. This completes the endoscopic mucosal resection.

  In FIGS. 10 and 11, the separated portion 5 a is cut along the cut portion 42 with the high-frequency knife 53 or the like from the side surface of the raised portion. However, since the connective tissue 7a in the injection portion 2c has already been cut due to the expansion of the exfoliation bulging member 110 as described above, the high-frequency knife 53 and the like from the side of the bulging portion where the visibility of the lesioned part 4 becomes poor It is not necessary to insert at least one of the scissors forceps 161. Therefore, in order to improve the visibility of the lesioned part 4 and perform the treatment easily and safely, the EMR treatment tool 100 and the EMR device 150 according to the present embodiment are internally viewed above the lesioned part 4 as shown in FIG. It is possible to dispose the tip 5 of the mirror 10 and cut the portion to be separated 5 a from above the lesioned part 4 along the excision site 42 with at least one of the high-frequency knife 53 and the scissors forceps 161. Further, since the connective tissue 7a is cut as described above, the portion to be separated 5a is separated from the non-affected portion 2b simply by cutting the portion to be separated 5a along the excision site. Therefore, the part to be separated 5a can be excised more easily and safely than in the past.

  As described above, according to the EMR treatment instrument 100 and the EMR apparatus 150 of the present embodiment, the exfoliation bulging member 110 in the EMR treatment instrument 100 is used to inflate the exfoliation bulge member 110 to include the lesioned part 4. The part to be separated 5a and the non-affected part 2b not including the lesioned part 4 were separated and separated, and at least the lesioned part 4, preferably the lesioned part 4 was included, and the peripheral part thereof was raised. Therefore, the disappearance of the bulge with the start of incision of the mucous membrane as in the prior art does not occur in the present embodiment, and therefore it is not necessary to bulge the affected part multiple times. It is possible to almost eliminate the possibility of occurrence of bleeding complications, leaving behind the lesion 4 and the like.

Furthermore, in this embodiment, the connective tissue 7a of the submucosal layer 2 is cut by the expansion of the exfoliation and bulging member 110 in the submucosal layer 2, in other words, between the part to be separated 5a and the non-affected part 2b. Since the separation bulging member 110 is interposed between the bulging portion 110 and the separation portion 5a, it is not necessary to insert the high-frequency knife 53 or the like from the side surface of the bulging portion and cut the connective tissue 7a. Therefore, in the present embodiment, the distal end portion of the endoscope 10 is disposed so as to face the lesioned part 4 so that the visibility of the lesioned part 4 by the endoscope 10 is improved, and a high-frequency knife is disposed from above the lesioned part 4. The portion to be separated 5a can be excised with at least one of 53 and the like and the scissors forceps 161. Therefore, the treatment is easier than in the past, and from this point also, in this embodiment, there is almost no possibility of complications such as perforation and bleeding, and the safety of the treatment can be improved, and the patient Can alleviate the burden.
Therefore, the EMR treatment tool 100 and the EMR apparatus 150 according to the present embodiment can perform endoscopic mucosal resection more easily and safely than the conventional one, and thus the operation time is significantly shortened compared to the conventional one. And the burden on the patient can be reduced.

  In the above-described embodiment, the peeling bulging member 110 of the EMR treatment tool 100 is expanded by supplying gas or liquid using the expansion tool 151. For example, the peeling bulging member is made of a water-absorbing material. May be formed so as to absorb water and the like in the submucosa 2 and expand itself.

  In the above-described embodiment, the exfoliation bulging member 110 is inflated so that the exfoliation bulge member 110 exfoliates and separates the part to be separated 5a including the lesioned part 4 and the non-affected part 2b not including the lesioned part 4. The operation and the operation of raising at least the lesioned part 4, preferably including the lesioned part 4 and the peripheral part thereof are performed in parallel. In order to perform the above-described ridge activation operation, the peeling bulge member 110 is relatively large. It may be difficult to insert and introduce such a large exfoliating and protruding member 110 into the submucosal layer 2 located below the lesioned part 4. Therefore, it is preferable to further include an insertion member 130 as shown in FIG. 19 that is included in the EMR treatment instrument 100 and is smaller in size than the exfoliation bulging member 110. The insertion member 130 is used before the exfoliation bulging member 110 is inserted into the submucosal layer 2, and previously forms an injection portion 2 c of the exfoliation bulge member 110 in the submucosal layer 2 for the separation and separation. Moreover, it is a member that performs the cutting operation of the connective tissue 7a of the submucosa 2 in accordance with the forming operation.

The shape of the insertion member 130 is not limited as long as the above-described forming operation of the injection portion 2c can be achieved. As an example of one form of the insertion member 130, a balloon-like form called an IB balloon as described below can be adopted. Such an insertion member 130 is a member that facilitates the insertion of the exfoliation / bulging member 110 into the submucosal layer 2, and the second introduction member 131 that supports the insertion of the insertion member 130 into the submucosal layer 2. The tip portion 131a is provided. Such an insertion member 130 is, for example, in the shape of a bag, made of an elastic material that can expand and contract, such as a rubber material or an elastomer material, and is inserted into the submucosal layer 2 in the same manner as the peeling bulging member 110. After that, the gas is swelled with the gas or liquid supplied through the second introduction member 131. Then, by the expansion, the connective tissue 7a is cut as described above, and the part to be separated 5a and the non-affected part 2b are separated and separated to form the injection part 2c into which the exfoliation bulging member 110 is inserted. .
Note that the insertion member 130 is merely inserted into the submucosal layer 2 in order to prevent the separation bulging member 110 from detaching from the submucosa 2 when the exfoliation bulging member 110 is expanded. And the range for separating and separating the portion to be separated 5a and the non-affected portion 2b is compared to the case of the peeling bulging member 110. small.

Further, as described above, the role of the insertion member 130 is to cut the connective tissue 7a and to separate and separate the part to be separated 5a and the non-affected part 2b from a part of the submucosa 2 to form an injection part 2c. It is to be. Therefore, when expanded by the supply of the gas or the like, the insertion member 130 spreads laterally from the front end portion 1301 toward the rear end portion 1302 rather than swells almost uniformly over the entire length like the peeling bulge member 110. It is preferable that the swells are successively elongated without any problems since the cutting and separating operations proceed smoothly. In order to perform such an expansion operation, in the insertion member 130, the thickness 1301 a of the insertion member 130 at the distal end portion 1301 is formed thinner than the thickness 1302 a at the rear end portion 1302, and It is shaped so that its thickness gradually increases toward the end portion 1302. For example, the thickness 1301a of the tip 1301 is about 150 μm, and the thickness 1302a of the rear end 1302 is about 200 μm. Can do.
In addition, when performing an operation using the insertion member 130 further, the thickness of the above-mentioned peeling bulge member 110 can be formed almost uniformly over the entire length.

  In addition, the size of the insertion member 130 is not necessarily required to be a size corresponding to the size of the lesioned part 4, but may be a size corresponding to at least the exfoliation bulging member 110. Note that the size of the insertion member 130 does not have to be the same as the size of the peeling bulge member 110 and is often smaller than the peeling bulge member 110. An example is about 1.5 to about 2 cm.

The second introduction member 131 is tubular and has the same size and function as the first introduction member 120 described above, and the above-described guide member 122 may be provided to support the second introduction member 131. . The substance injected into the second introduction member 131 is the same as that of the first introduction member 120. The gas is, for example, air, and the liquid is, for example, water, physiological saline, or a gel-like drug. is there.
As described above, the insertion member 130 preferably swells sequentially from the front end portion 1301 toward the rear end portion 1302. In order to achieve the expanded state, as shown in FIG. 19, the distal end of the second introduction member 131 is positioned in the vicinity of the distal end portion 1301 of the insertion member 130 in the attachment state of the insertion member 130 to the second introduction member 131. It is preferable that the distal end portion of the second introduction member 131 is inserted inside the elongated insertion member 130 to the extent that it is disposed, and only the rear end portion 1302 of the insertion member 130 is joined to the second introduction member 131.
When both the peeling bulge member 110 and the insertion member 130 are used, as will be described later, after the insertion member 130 separates the separated portion 5a and the non-affected portion 2b by expansion, its role is as follows. Since the process is completed, it is shrunk and taken out of the body together with the second introduction member 131. Therefore, the insertion member 130 does not need to be provided with the above detaching mechanism 115.
Further, since the second introduction member 131 is also inserted into the submucosa 2 in the same manner as the first introduction member 120, the tip portion of the second introduction member 131 is the same as the tip portion of the first introduction member 120. It is preferable to use a weakly straight shape.

The endoscopic mucosal resection performed using the EMR apparatus 150 including the EMR treatment tool 100 further including the insertion member 130 attached to the distal end portion of the second introduction member 131 described above will be described below. .
First, with respect to the lesioned part 4 existing in the mucous membrane layer 5 of the living body cavity 1 shown in FIG. 6, the puncture injection needle or the like is placed below the lesioned part 4 through the endoscope 10 as shown in FIG. The lesioned part 4 is slightly raised by piercing the separation position 2a in the lower layer 2 and injecting a small amount of, for example, physiological saline. The ridge activation operation is for creating a space for inserting the insertion member 130 described below. The separation position 2a is an arbitrary position in the thickness direction of the submucosa 2 as described above.

  Next, a small hole reaching the submucosal layer 2 is made in the lesion peripheral part 4a with a high-frequency knife or the like through the endoscope 10, and then inserted into the EMR treatment instrument 100 as shown in FIGS. The second introduction member 131 provided with the working member 130 is inserted into the forceps channel 12 of the endoscope 10, and is further attached to the distal end portion of the second introduction member 131 or the distal end portion through the small hole to the injection portion 2c. The distal end portion 1301 of the insertion member 130 is inserted.

Next, as shown in FIGS. 21 and 26, the gas or the liquid is supplied using the inflation tool 151 connected to the rear end portion 1311 located outside the patient body 52 in the second introduction member 131. The material is supplied to the insertion member 130 through the second introduction member 131. As described above, the insertion member 130 is made by reducing the thickness 1301a of the front end portion 1301 and gradually increasing the thickness from the front end portion 1301 toward the rear end portion 1302. First, the tip 1301 swells. At this time, since the distal end portion 1301 of the insertion member 130 is inserted into the injection portion 2c through the small hole, the expanded distal end portion 1301 cannot pass through the small hole. That is, the small hole serves as a stopper, and the insertion member 130 can be prevented from being pushed back into the living body cavity 1 from the submucosa 2 as the insertion member 130 swells. Further, as described above, the insertion member 130 swells sequentially from the front end portion 1301 to the rear end portion 1302 side. Therefore, as the insertion member 130 expands, as shown in FIGS. 22 and 27 and FIGS. 23 and 28 in the order of FIGS. 22 and 27 and FIGS. The connective tissue 7a is cut through the submucosa 2 while being cut, and the above-mentioned separated portion 5a and the non-affected portion 2b having no lesion 4 under the separated portion 5a are separated and separated in the submucosa 2. However, the injection part 2c is formed.
Since the insertion member 130 swells along the axial direction as described above, the range to be separated and separated is an elongated range as shown in FIGS. The range is not substantially circular with the portion 4 as the center. In this way, the insertion member 130 forms a guide pit for insertion of the peeling and bulging member 110.

At least when the above-described separation operation by the insertion member 130 is completed for at least the portion to be separated 5a corresponding to the lesioned part 4, the expansion tool 151 is removed, and the expansion of the insertion member 130 is released and contracted. After contraction, the second introduction member 131 and the insertion member 130 are taken out of the body through the endoscope 10.
After the second introduction member 131 and the insertion member 130 are taken out, as shown in FIGS. 8 and 9 described above, the first introduction member 120 of the EMR treatment instrument 100 and the separation protrusion are applied to the forceps channel 12 of the endoscope 10. The member 110 is inserted, and the distal end portion of the first introduction member 120 and the peeling bulge member 110 are inserted through the small hole into the injection portion 2 c in the submucosa 2 formed by the insertion member 130. Thereafter, as described above, the exfoliation bulging member 110 is expanded to perform endoscopic mucosal resection. It should be noted that the separated portion 5a and the non-affected portion 2b are separated and separated by the ridge activation operation by the separation bulging member 110.

  As described above, the separation bulging member 110 can be easily moved to the submucosal layer 2 by previously forming the insertion ridge for inserting the separation bulging member 110 in the insertion member 130, that is, the injection portion 2c. It can be inserted, and when the exfoliation bulge member 110 is expanded, the exfoliation bulge member 110 can be prevented from slipping out of the submucosa 2. Therefore, the peeling and bulging member 110 can easily bulge at least the lesioned part 4, preferably including the lesioned part 4, and its peripheral part. Therefore, compared with the case where the separation operation is also performed using only the peeling bulge member 110, the treatment can be easily performed. Therefore, the possibility of generating complications such as perforation and bleeding and leaving the lesioned part 4 is lower, the safety of the treatment can be further improved, and the burden on the patient can be further reduced.

The above description is for the case where both the insertion member 130 and the peeling bulging member 110 are used. However, the characteristic points of the insertion member 130 and the peeling bulging member 110 as shown in FIG. 24 are combined. It is also possible to produce the insertion peeling protruding member 140 formed integrally. Similar to the insertion member 130, the insertion peeling protrusion member 140 gradually increases the thickness of the insertion peeling protrusion member 140 from the front end portion 1401 toward the rear end portion 1402, and is provided with a detachment mechanism 115. ing. Note that the insertion / separation bulging member 140 does not have to be provided with the detaching mechanism 115, and may take the form shown in FIGS.
The insertion peeling member 140 has the same configuration and function as the first introduction member 120 and the second introduction member 131 in the same manner as the insertion member 130 and the separation protrusion member 110. The first introduction member 120 and the second introduction member 131 are attached to the tip of the third introduction member 141 formed integrally.

  According to the above-mentioned insertion peeling member 140, the separation and separation operation of the part to be separated 5a and the non-affected part 2b and the bulge starting operation of the part to be separated 5a can be performed with one member. It is possible to reduce the burden on patients associated with shortening.

  The present invention can be applied to an EMR treatment tool used for endoscopic mucosal resection and an EMR apparatus equipped with the EMR treatment tool.

It is a figure which shows the treatment tool for EMR in embodiment of this invention. It is a figure which shows the other example of the treatment tool for EMR in embodiment of this invention. It is a figure which shows the other example of the treatment tool for EMR in embodiment of this invention, Comprising: It is a figure which shows the example which has a desorption mechanism. It is a figure which shows the state which removed the 1st introduction member from the treatment tool for EMR shown in FIG. It is a figure which shows the front-end | tip part of the endoscope with which the EMR apparatus in embodiment of this invention is equipped. It is a figure which shows the lesioned part in a living body cavity, and its vicinity. It is a figure for demonstrating the endoscopic mucosal resection performed using the EMR apparatus which has the treatment tool for EMR in embodiment of this invention, and is a figure which shows the state injected into the submucosa. It is a figure for demonstrating the endoscopic mucosal resection performed using the EMR apparatus which has the treatment tool for EMR in embodiment of this invention, and is a figure which shows the state which inserted the EMR treatment tool in the submucosa. . It is a figure for demonstrating the endoscopic mucosal resection performed using the EMR apparatus which has the treatment tool for EMR in embodiment of this invention, and shows the state which the member for peeling protrusion inserted in the submucosal layer was inflated FIG. It is a figure for demonstrating endoscopic mucosal resection performed using the EMR apparatus which has the treatment tool for EMR in embodiment of this invention, and is a figure for demonstrating a lesioned part excision. It is a figure for demonstrating endoscopic mucosal resection performed using the EMR apparatus which has the treatment tool for EMR in embodiment of this invention, and is a figure for demonstrating a lesioned part excision. It is a figure for demonstrating the endoscopic mucosal resection performed using the EMR apparatus which has the treatment tool for EMR in embodiment of this invention, and is the figure which showed the lesioned part and the excision location planarly. It is a figure which shows the modification of the 1st introduction member shown in FIG. 1, and is a figure which shows the example which provided the guide member in the 1st introduction member. It is a figure which shows the modification of the 1st introduction member shown in FIG. It is a figure for demonstrating the modification of the endoscopic mucosal resection shown in FIG.10 and FIG.11, and is a figure for demonstrating a lesioned part excision. It is a perspective view which shows the whole endoscope. It is a figure which shows the example of a shape when the member for peeling protrusion shown in FIGS. 1-3 is expanded. It is a figure which shows the example of a shape when the member for peeling protrusion shown in FIGS. 1-3 is expanded. It is a figure which shows the example of a shape when the member for peeling protrusion shown in FIGS. 1-3 is expanded. It is a figure which shows the scissors forceps with which the EMR apparatus in embodiment of this invention is equipped. It is a figure which shows the member for insertion contained in the treatment tool for EMR in embodiment of this invention. In the endoscopic mucosal resection performed using the EMR apparatus having the EMR treatment tool according to the embodiment of the present invention, the operation for forming the injection portion for inserting the separation bulge member by the insertion member shown in FIG. It is sectional drawing for demonstrating. In the endoscopic mucosal resection performed using the EMR apparatus having the EMR treatment tool according to the embodiment of the present invention, the operation for forming the injection portion for inserting the separation bulge member by the insertion member shown in FIG. It is sectional drawing for demonstrating. In the endoscopic mucosal resection performed using the EMR apparatus having the EMR treatment tool according to the embodiment of the present invention, the operation for forming the injection portion for inserting the separation bulge member by the insertion member shown in FIG. It is sectional drawing for demonstrating. In the endoscopic mucosal resection performed using the EMR apparatus having the EMR treatment tool according to the embodiment of the present invention, the operation for forming the injection portion for inserting the separation bulge member by the insertion member shown in FIG. It is sectional drawing for demonstrating. It is a figure which shows the further another modification of the treatment tool for EMR in embodiment of this invention. It is a top view of FIG. It is a top view of FIG. FIG. 23 is a plan view of FIG. 22. It is a top view of FIG. It is a figure for demonstrating the conventional endoscopic mucosal resection.

Explanation of symbols

1 ... biological cavity, 2 ... submucosa, 2b ... non-affected part,
4 ... lesioned part, 5 ... mucosal layer, 5a ... part to be separated, 10 ... endoscope,
DESCRIPTION OF SYMBOLS 100 ... EMR treatment tool, 110 ... Exfoliation raising member, 115 ... Desorption mechanism,
120 ... first introduction member, 121 ... tip portion, 130 ... insertion member,
131 ... second introduction member, 131a ... tip portion, 150 ... EMR device,
151 ... Inflation tool.

Claims (9)

After being inserted into the body cavity (1) through the endoscope (10), the lesion is inserted into the submucosa (2) located below the lesion (4) existing in the mucosa layer (5) of the body cavity. An exfoliating and protruding member (110) that exfoliates and separates the part to be separated (5a) in which the part exists and the non-affected part (2b) that does not have the lesion part under the part to be separated and raises the lesion part. )When,
A first introduction member (120) connected to the tip portion (121) and supporting the insertion of the exfoliation protuberance member into the submucosa layer;
A treatment tool for EMR, comprising:   The exfoliation bulging member has a bag-like shape, is made of a material that expands with a gas or liquid supplied through the first introduction member, and has a size that bulges the lesion by the expansion. The treatment tool for EMR according to claim 1.   The treatment device for EMR according to claim 1 or 2, wherein the exfoliation bulge member is made of a heat-resistant material that can withstand heat when the bulged lesion is excised.   The EMR according to any one of claims 1 to 3, further comprising: a desorption mechanism (115) for detaching the first introduction member from the exfoliation bulge member while maintaining a raised state of the lesioned portion by the exfoliation bulge member. Treatment tool. A member for facilitating insertion of the exfoliation and protuberance member into the submucosal layer, having a separated portion (5a) inserted into the submucosal layer and having the lesioned portion, and the lesioned portion under the separated portion. An insertion member (130) that forms an injection part (2c) into which the exfoliation bulge member is inserted and separated from an unaffected part (2b)
The said insertion member is provided in the front-end | tip part (131a), The 2nd introduction member (131) which supports insertion in the said submucosa of the said insertion member was further provided, The any one of Claim 1 to 4 The treatment tool for EMR described in 1.   6. The EMR treatment tool according to claim 5, wherein the insertion member is formed integrally with the peeling and protruding member, and the first introduction member and the second introduction member are formed integrally. The treatment tool for EMR (100) according to any one of claims 1 to 4,
An endoscope that is inserted from outside the living body into the living body cavity (1), the endoscope (10) through which the EMR treatment tool is inserted and that guides the EMR treatment tool into the living body cavity;
An EMR apparatus comprising:   Supporting the exfoliation / bulge member (110), which is an introduction member constituting the treatment device for EMR, and raises the lesion (4) existing in the mucosa layer (5) of the living body cavity, and to the exfoliation / bulge member An inflatable device (151) that is connected to a first introduction member (120) for injecting a gas or a liquid in vitro to inflate the exfoliation bulge member to bulge the lesion. Item 8. The EMR device according to Item 7. The EMR treatment instrument is a member for facilitating the insertion of the exfoliation bulging member into the submucosal layer, and a portion to be separated (5a) inserted into the submucosal layer and having the lesioned portion, and the separation target. An insertion member (130) that forms an injection portion (2c) into which the exfoliation bulging member is inserted by separating the unaffected portion (2b) that does not have the lesioned portion under the portion;
Supporting the exfoliation / bulge member (110), which is an introduction member constituting the treatment device for EMR, and raises the lesion (4) existing in the mucosa layer (5) of the living body cavity, and to the exfoliation / bulge member The first introduction member (120) for injecting the gas or the liquid is in vitro connected to the first introduction member (120), the exfoliation bulge member is inflated to bulge the lesion, and the EMR treatment instrument is constructed. An expansion tool that is connected to a second introduction member (131) that supports the insertion member and injects gas or liquid into the insertion member ex vivo and expands the insertion member. The EMR apparatus according to claim 7, further comprising (151).

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