JP2019092843A - Laser transmission line, laser treatment instrument, laser treatment device, and laser treatment system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a reduced diameter laser transmission line, a laser treatment apparatus, and a laser treatment system in laser medical treatment. SOLUTION: A hollow waveguide 62 for guiding a laser beam 56a is fixed so as to be integrated with the hollow waveguide 62, and an exterior composed of a metal flat plate surrounding the outer periphery of the hollow waveguide 62. The exterior member 64 is composed of a member 64 and a laser chip mounting portion 61a provided on one end side of the hollow waveguide 62 to which a laser chip 70 for irradiating the affected portion with laser light 56a is attached. The laser transmission path 60 is formed of a multi-layer structure and is composed of a tubular torque transmitter that transmits torque on the other end side to the tip side. [Selection diagram] Fig. 3

Description

  The present invention relates to, for example, a laser transmission path for guiding laser light, a laser treatment tool having a laser chip mounted on the tip of the laser transmission path, a laser treatment apparatus provided with the laser treatment tool, and a laser treatment system.

  In recent years, in the medical and dental fields, development of a treatment method with less burden on patients has been advanced. For example, surgical or medical treatment using an endoscope is performed as minimally invasive medicine. Endoscopic submucosal dissection (ESD), which targets especially gastrointestinal cancer, has attracted attention as an effective treatment method with a low burden on patients. Such treatment is performed using a treatment device using an electrosurgical knife or a laser.

  As a laser treatment apparatus using a laser beam, as disclosed in, for example, Patent Document 1, it is general to provide a laser transmission path covered with a bellows-like exterior member around a flexible fiber. . Thus, the fiber for guiding the laser light can be emitted in a desired direction, and the exterior member can prevent the laser light from leaking to the outside even if the fiber is broken.

  However, since the laser transmission path as disclosed in Patent Document 1 has a configuration in which the outer periphery of the fiber is covered with an exterior member having a bellows structure, the outer diameter of the laser transmission path inevitably becomes large. The passage could not be inserted into the device insertion port of the endoscope. In particular, the diameter reduction of the laser transmission path has become a major issue in recent years in which the diameter reduction of the endoscope has been advanced to reduce the burden on the patient.

Unexamined-Japanese-Patent No. 2004-321463

  Then, an object of the present invention is to provide a laser treatment apparatus and a laser treatment system provided with a diameter-reduced laser transmission line, the laser transmission line, in view of the above-mentioned problems.

According to the present invention, a light guide member for guiding laser light, an exterior member made of a flat metal plate fixed so as to be integrated with the light guide member and surrounding the outer periphery of the light guide member A mounting portion on one end side of the light guide member to which the laser chip is attached, and the exterior member is formed of a flexible multi-layer structure, and the torque on the other end is tipped It is characterized in that it is a laser transmission line constituted by a cylindrical torque transmission body to be transmitted to the side.
Further, according to the present invention, there is provided a laser treatment tool including the above-described laser transmission line and a laser chip attached to the attachment portion in the laser transmission line.

Further, according to the present invention, there is provided a laser treatment apparatus comprising: the above-described laser treatment tool; and a laser oscillator connected to the other end of the laser transmission path for oscillating a carbon dioxide gas laser beam.
Furthermore, the present invention is characterized in that it is a laser treatment system constituted by the above-mentioned laser treatment apparatus and an endoscope which can insert the laser transmission path.

The light guide member may be solid or hollow as long as it has a transmission efficiency suitable for the laser light to be guided.
Fixing so as to be integral as described above includes the case where a portion of the light guide member and the exterior member is fixed directly or indirectly. For example, in the case of fixing the fixing member for fixing the light guide member to the exterior member, or one or more points of the distal end, the base end, and the central portion of the light guide member and the exterior member. In this case, the fixing member for fixing the light guide member and the tip portion of the exterior member may be fixed directly or indirectly.

The torque transfer body refers to a cylindrical body formed by spirally winding a metal plate so as to form a multilayer structure and by overlapping an inner layer and an outer layer. In addition, the structure where the winding direction of each layer is constant, and the structure where the winding direction differs for every layer are also included.
The metal plate includes the same or different plate widths for each layer, and also includes the case where the winding pitch is the same or different.

According to the present invention, the diameter of the laser transmission path can be reduced.
If it explains in full detail, the outside diameter of the exterior member corresponding to the plate thickness by a metal plate is the above-mentioned by forming the above-mentioned exterior member constituted by the flat metal product by multilayer structure and surrounding the perimeter of the above-mentioned light guide member. Since the outer diameter of the laser transmission line can be obtained, the diameter of the laser transmission line can be reduced.

  In addition, even if the light guide member is damaged, since the exterior member surrounding the outer periphery of the light guide member is made of metal forming a multilayer structure, the leakage from the damaged portion is caused. It is possible to prevent the laser beam from being blocked by the exterior member and leaking to the outside of the laser transmission path.

  Furthermore, since the exterior member is fixed so as to be integral with the light guide member, the rotation on the other end side of the exterior member can be transmitted to the one end side, so that the one end side of the light guide member Can be rotated by a desired rotation amount, and one end side of the light guide member can be positioned by finely adjusting in the circumferential direction.

  Thus, for example, when the assist gas is jetted from the front end side of the laser transmission path or the laser chip is mounted, the exterior member formed of the torque transmission body is rotated by rotating the other end side. The tip end side can be rotated following the position to finely adjust the position of the assist gas injection port and the direction of the laser chip in the circumferential direction. Therefore, the assist gas can be jetted from a desired position, or the laser chip can be arranged in a desired direction.

As an aspect of the present invention, a first layer in which the exterior member is spirally wound and covers the outer periphery of the light guide member, and a spiral in which the outer periphery of the first layer is wound in the opposite direction to the first layer And the second layer.
In the first layer and the second layer, for example, when flat metal plates are arranged at a predetermined coil gap, or the metal plates forming the first layer and the second layer form a plane along the longitudinal direction. Or the metal plates forming the first layer and the second layer overlap in the longitudinal direction, and the first layer and the second layer have the same configuration. There is no need.

According to the present invention, the torque due to the rotation operation performed on the rear end side of the laser transmission path can be reliably transmitted to the front end side.
For example, when the laser transmission path is rotated in the same positive direction as the direction in which the first layer is wound on the rear end side of the laser transmission path, the first layer is clamped to the light guiding member. Thus, the torque in the positive direction can be transmitted to the tip of the laser transmission path. On the other hand, when the laser transmission path is rotated in the direction opposite to the winding direction of the first layer on the rear end side of the laser transmission path, the first layer is loosened with respect to the light guide member However, since the second layer is tightened with respect to the light guide member, torque in the reverse direction can be transmitted to the tip of the laser transmission path.
For this reason, it is possible to reliably transmit the torque due to the rotation operation performed on the rear end side of the laser transmission path to the front end side.

As an aspect of this invention, the outer peripheral surface of the said exterior member may be enclosed by the resin outer layer protection member which has water repellency.
The outer layer protection member includes, for example, a resin outer protection tube, a resin coating, a heat-shrinkable tube, and the like.

  According to the present invention, when the laser transmission path is inserted into the device insertion path provided in the endoscope, the laser transmission path can be smoothly inserted into the device insertion path, and the device insertion path It can be prevented from being damaged.

  More specifically, since the exterior member is surrounded by the resin outer layer protection member, the outer diameter of the exterior member can be prevented from expanding, and the space between the metal exterior member and the device insertion path can be prevented. By providing the outer layer protection member, it is possible to prevent the exterior member from being caught with the laser transmission path. Therefore, the laser transmission path can be smoothly inserted into the device insertion path, and the exterior member can be prevented from damaging the device insertion path.

  In addition, since the outer layer protecting member is waterproof, it is possible to prevent the liquid such as physiological saline, washing water, and body fluid from intruding into the inside from the outside of the exterior member. Thereby, the inside can be prevented from being corroded or contaminated by the liquid which has invaded by the exterior member.

  Furthermore, by surrounding the outer peripheral surface of the exterior member with the outer layer protection member, it is possible to prevent the cooling water from leaking from the inside to the outside of the exterior member. Even if the light guide member is damaged, the laser light leaked from the laser transmission path absorbs the laser energy by the cooling water flowing to the cooling path, so the outer layer protection member suppresses the deformation of the exterior member At the same time, the laser beam can be prevented from leaking to the outside.

  As an aspect of the present invention, the outer layer protecting member may be constituted by a heat-shrinkable tube which shrinks by heating.

  According to the present invention, since the exterior member can be easily surrounded by the outer layer protection member and the thickness of the outer layer protection member can be reduced, the diameter of the laser transmission path can be reduced while having a waterproof function. it can.

Further, as an aspect of the present invention, a cooling path may be provided between the light guide member and the exterior member, for circulating a cooling medium along the light guide member.
The cooling medium includes distilled water or tap water, a gas such as air or nitrogen gas, or a gel-like substance.

  According to the present invention, the light guide member heated by the laser light can be cooled by the cooling medium flowing through the cooling path. Therefore, the durability of the laser transmission path that can reliably treat the treatment target site with the laser light can be improved.

  Further, as an aspect of the present invention, the cooling path is constituted by a first cooling path and a second cooling path formed along the light guide member, and the first cooling path and the second cooling path are provided at one end side. A communication portion may be provided to communicate the

  According to the present invention, the cooling medium which has flowed through one of the first cooling path and the second cooling path can flow to the other through the communication path, so that the cooling medium can be recovered. Therefore, the cooling medium can be circulated to efficiently cool the hollow waveguide heated by the laser light. Further, the cooling medium can be circulated in the first cooling path or the second cooling path without the cooling medium leaking to the treatment target site.

  According to the present invention, it is possible to provide a diameter-reduced laser transmission line, a laser treatment apparatus provided with the laser transmission line, and a laser treatment system.

The schematic block diagram of the treatment system by an endoscope apparatus and a laser treatment apparatus. The block diagram which shows the structure of an endoscope apparatus and a laser treatment apparatus. FIG. 3 is an enlarged perspective view of a tip portion of a laser transmission path and a laser chip. The laser chip and the expansion disassembled perspective view in the tip part of the laser transmission line which removed the laser chip. Explanatory drawing of a laser transmission line. Explanatory drawing of a laser transmission line. Explanatory drawing of the method of cut | disconnecting a biological tissue. FIG. 10 is an enlarged perspective view of a tip portion of a laser transmission path and a laser chip in another embodiment. FIG. 10 is an enlarged perspective view of a tip portion of a laser transmission path and a laser chip in another embodiment. Explanatory drawing of the laser transmission line in other embodiment.

An embodiment of the invention will now be described in conjunction with the drawings.
FIG. 1 is a block diagram showing a schematic configuration of a laser treatment system 1 configured of an endoscope apparatus 10 and a laser treatment apparatus 50, and FIG. 2 shows configurations of the endoscope apparatus 10 and the laser treatment apparatus 50. It is a block diagram shown.

The laser treatment system 1 includes an endoscope device 10 and a laser treatment device 50. In the endoscope apparatus 10, as shown in FIG. 1, an operator operation unit 12 is connected to a main body of the apparatus by a connection cable 11.
The operator operation unit 12 mainly includes an operation unit 13 and an endoscope tube 21.

The operation unit 13 is provided with an eyepiece unit 15, an upper and lower angle knob 16, a left and right angle knob 17, an operation button 18, a device insertion port 20, and the like.
The operation button 18 receives operation inputs such as air supply, water supply, suction, and zoom.

  The endoscope tube 21 is provided with a flexible tube portion 22, a curved tube portion 23, and a tip end configuration portion 30 in this order from the base (rear end) to the tip. Further, inside the endoscope tube 21 is provided a device insertion path 19 communicating from the device insertion port 20 to the device outlet 36 of the distal end forming portion 30. The device insertion path 19 functions as a therapeutic device insertion path for inserting a therapeutic device such as a forceps or a laser transmission path 60.

  Although FIG. 1 illustrates that the diameter of the flexible tube portion 22 is expanded from the middle of the flexible tube portion 22 to the tip of the curved tube portion 23, this is for drawing the configuration of the tip configuration portion 30 in an easy-to-understand manner In fact, it has a shape such as esophagus, stomach, intestine, etc., which has a constant diameter, which is suitable for being inserted into a living body.

The flexible tube portion 22 has a cylindrical shape that bends appropriately, and can insert a therapeutic device such as an appropriate forceps or the like from the device insertion port 20 to the distal end configuration portion 30. In this embodiment, a laser transmission path 60 connected to the laser treatment apparatus 50 as a treatment device is inserted. In addition, the laser transmission path 60 comprises the laser treatment tool 80 with the laser chip 70 assembled | attached to a front-end | tip.
The bending tube portion 23 is bent in the vertical direction by the operation of the upper and lower angle knobs 16 and is bent in the left and right direction by the left and right angle knobs 17.

The tip end configuration unit 30 is provided with light guides 31 and 35, an auxiliary water supply port 32, a lens 33, a nozzle 34, and a device outlet 36.
The light guides 31 and 35 are illumination portions that emit light serving as illumination for imaging. This makes it possible to illuminate and observe the inside of the body where light does not reach.

The auxiliary water supply port 32 is a water supply port for releasing a liquid such as washing water or a staining liquid for washing the affected area in an endoscope or the like.
The lens 33 is a lens for collecting light by illumination of the light guides 31 and 35 and acquiring a captured image, and an imaging element disposed behind the lens.

The nozzle 34 is a part that discharges a cleaning liquid or the like for cleaning the lens 33 toward the lens 33.
The device outlet 36 is the outlet of a therapeutic device such as the laser transmission line 60 of the laser therapeutic device 50. The laser transmission path 60 is formed to be longer than the device insertion path length which is also the entire length of the endoscope tube 21. The details of the laser transmission path 60 will be described later.

The endoscope apparatus 10 is provided with an operation unit 41, a power supply unit 42, a central control unit 43, an illumination unit 44, an imaging unit 45, a water injection unit 46, and an image display unit 47, as shown in FIG. .
The operation unit 41 transmits an operation input from the operation unit 13 (see FIG. 1) to the central control unit 43. That is, the bending operation of the bending tube portion 23 by the operation of the upper and lower angle knobs 16 and the left and right angle knobs 17 and the pressing operation by the operation button 18 are transmitted. Alternatively, separately from the operator operation unit 12, for example, an operation unit is provided in a controller main body (not shown) of the endoscope apparatus 10, and central control of operations such as light amount of illumination and photographing and storage of still images Transmit to section 43.

The power supply unit 42 supplies operation power to each unit such as the central control unit 43, and the central control unit 43 executes various control operations on each unit.
The illumination unit 44 executes illumination from the light guides 31 and 35 (see FIG. 1).

  The imaging unit 45 captures an image transmitted from the lens 33 and an imaging device (see FIG. 1) disposed behind the lens 33, and obtains a captured image necessary for the operation or performs image processing. By continuously acquiring the captured images in real time, the operator can smoothly perform the operation.

  The water injection unit 46 executes the injection of the liquid from the auxiliary water supply port 32. In addition, ejection of liquid from the nozzle 34 is also performed. As described above, the imaging unit 45 may be provided in the vicinity of the distal end configuration unit 30 or may be provided in the controller main body (not shown) of the endoscope apparatus 10.

  The image display unit 47 displays an image in accordance with the signal transmitted from the central control unit 43. The image also includes a captured image acquired by the imaging unit 45. Therefore, the operator can perform treatment while confirming the captured image displayed on the image display unit 47 in real time.

As shown in FIG. 2, the laser treatment apparatus 50 includes an operation unit / display unit 51, a power supply unit 52, a central control unit 54, a guide light emission unit 55, a laser oscillation unit 56, a cooling water discharge unit 57, and a gas release unit 58. Is equipped.
The operation unit / display unit 51 receives an operation input such as setting of laser output or change of operation mode, transmits an input signal to the central control unit 54, and the output condition of the laser from the central control unit 54 To display the appropriate information.
The power supply unit 52 supplies operating power to each unit such as the central control unit 54.

The central control unit 54 executes various control operations on each unit. The central control unit 54 includes a laser output control unit 54a, a storage unit 54b, a gas control unit 54c, and a cooling water control unit 54d.
The laser output control unit 54 a controls the output value of the laser beam 56 a by the laser oscillation unit 56 in accordance with the output set by the operation unit / display unit 51 and the operation mode. The storage unit 54 b stores appropriate data in addition to control data such as output settings and operation mode setting contents.

  The guide light emitting unit 55 emits a guide light 55a for indicating the position where the therapeutic laser light 56a is irradiated. The guide light 55a can confirm the position where the therapeutic laser light 56a is irradiated.

The laser oscillation unit 56 executes oscillation of the laser beam 56a for treatment used for the treatment. In this embodiment, a carbon dioxide gas laser is used as the laser beam 56a. Operations such as setting of irradiation intensity of carbon dioxide gas laser and start / stop of irradiation are performed by manual operation by the operation unit / display unit 51 and control output by the central control unit 54. Note that part or all of the manual operation can be replaced with a stepping operation using a foot controller (not shown) provided so as to be able to communicate and control the laser treatment apparatus 50.
The guide light 55 a irradiated by the above-described guide light emitting unit 55 and the laser light 56 a oscillated by the laser oscillation unit 56 are all transmitted by one laser transmission path 60.

The cooling water discharge unit 57 executes the supply of the cooling water 57a for cooling the hollow waveguide 62 heated by the laser beam 56a and the recovery of the supplied cooling water 57a. The cooling water 57a can be circulated and supplied again after being collected. Further, in this embodiment, distilled water is used as the cooling water 57a, and the discharge amount of the cooling water 57a is performed by the manual operation by the operation unit / display unit 51 and the control output by the central control unit 54.
The cooling water 57a may be replaced with tap water, a gas such as air or nitrogen gas, or a gel-like substance.

  The gas release unit 58 shown in FIG. 2 performs release of the release gas 58 a to be inserted into the laser transmission path 60. In this embodiment, compressed air is used as the release gas 58a.

Next, the structure of the laser transmission path 60 and the structure of the laser chip 70 mounted on the tip of the laser transmission path 60 will be described with reference to FIGS. 3 to 5.
FIG. 3 shows an enlarged perspective view of the tip of the laser transmission line 60, and more specifically shows an enlarged schematic perspective view of the laser transmission line 60 with the laser chip 70 mounted on the tip, and FIG. The enlarged schematic perspective view of the laser transmission line 60 and the laser chip 70 is shown, and FIG.5 and FIG.6 shows explanatory drawing of the laser transmission line 60. As shown in FIG.

5 (a) is a schematic perspective view of the tip of the laser transmission line 60, and FIG. 5 (b) is a side view of the laser transmission line 60 in FIG. 5 (a). Show. 5 (a) and 5 (b), in order to clarify the configuration of the laser transmission line 60, a part of the exterior member 64 is omitted, and a part of the hollow waveguide 62 and the outer layer tube 65 is used. , And is shown by a broken line so as to indicate the transmitted state.
Fig.6 (a) shows AA sectional drawing in FIG. 3, FIG.6 (b) shows BB sectional drawing in Fig.6 (a).

The laser transmission path 60 is a hollow cylindrical body formed to be longer than the endoscope tube 21 and, as shown in FIGS. 3 to 6, a mounting portion 61 for mounting the laser chip 70 at the tip, A hollow waveguide 62 for guiding the laser beam 56a, a water channel forming tube 63 surrounding the outer periphery of the hollow waveguide 62, an exterior member 64 surrounding the outer periphery of the water channel forming tube 63, and an outer layer tube 65 are provided.
As shown in FIGS. 4 to 6, in the mounting portion 61, the laser chip mounting portion 61a, the tube connection portion 61b, and the exterior member fixing portion 61c are arranged side by side from the front end to the rear end.

The laser chip mounting portion 61a is a substantially cylindrical body fixed to the tip of the laser transmission path 60, and a screw thread 61d along the optical axis direction D is provided on the outer peripheral surface. The screw thread 61 d is screwed and fixed by a screw formed on the inner diameter of the end portion of the laser chip 70.
The tube connecting portion 61b is a cylindrical body provided at the rear end of the laser chip mounting portion 61a, and has an outer diameter larger than the laser chip mounting portion 61a and slightly smaller than the inner diameter of the device insertion path 19. .

As shown in FIGS. 5 (a) and 6 (a), the exterior member fixing portion 61c has an outer diameter substantially the same as the outer diameter of the laser chip mounting portion 61a, which will be described later. It is formed of a cylindrical body having an inner diameter substantially the same as the outer diameter.
In the mounting portion 61 configured in this manner, a hollow is provided in the central portion, and the hollow waveguide 62 is fixed to the hollow portion.

  The hollow waveguide 62 is a cylindrical body having the same outer diameter as the inner diameter of the exterior member fixing portion 61c as described above, and the entire inner surface is covered with a dielectric thin film (not shown). And a laser irradiation port 62b for irradiating the laser beam 56a at the tip.

  The cylindrical body constituting the hollow waveguide 62 is formed in a long shape of a material such as a glass tube having a smooth surface and being suitable for the formation of a reflective film such as silver or a dielectric thin film, and the dielectric thin film is COP It is formed of an appropriate material that efficiently reflects and transmits laser light, such as (cyclic olefin polymer) and polyimide.

  In the present embodiment, since the inner peripheral surface of the hollow waveguide 62 is covered with a silver reflective film and a dielectric thin film, the transmission efficiency of the laser beam 56a conducted in the hollow waveguide 62 (conductive space 62a) is high. Can be conducted.

Since the hollow waveguide 62 configured in this way has the same outer diameter as the inner diameter of the exterior member fixing portion 61c, the hollow waveguide 62 can be fixed by inserting the hollow waveguide 62 into the exterior member fixing portion 61c. Thus, the tip of the hollow waveguide 62 is integrally fixed to the rear end of the laser chip mounting portion 61a, and the laser light 56a guided by the hollow waveguide 62 is irradiated from the tip of the laser chip mounting portion 61a. be able to.
In the fixed state in which the hollow waveguide 62 is fixed to the mounting portion 61, the laser irradiation port 62b is fixed in a state of slightly projecting from the tip of the laser chip mounting portion 61a (see FIG. 5B).

The water channel forming tube 63 is a long hollow tube having an inner diameter one size larger than the outer diameter of the hollow waveguide 62 as shown in FIG. 4 to FIG. 6, and is made of flexible resin There is.
Further, the water channel forming tube 63 is fixed to the joint body at the rear end side (not shown), and the length in the longitudinal direction is slightly shorter than the hollow waveguide 62. Therefore, in the state where the hollow waveguide 62 is fixed to the exterior member fixing portion 61c, a space is slightly formed between the tip end of the water channel forming tube 63 and the rear end side of the exterior member fixing portion 61c. There is. The cooling water 57a passing forward through the annular space formed between the water channel forming tube 63 and the outer periphery of the hollow waveguide 62 is directed rearward through this space, ie, the communication passage 68, of the water channel forming tube 63. Refluxing occurs as illustrated by the arrows through the annular space formed on the outside and the inside of the exterior member 64.

  The exterior member 64 has a configuration in which a stainless steel metal plate is spirally wound along the outer peripheral surface of the water channel forming tube 63, and the front end and the rear end are respectively an exterior member fixing portion 61c and a joint main body (not shown). It is fixed. As shown in FIGS. 5 (a) and 5 (b), the exterior member 64 is formed by stacking the first layer 64a, the second layer 64b, and the third layer 64c from the inner diameter side toward the outer diameter side. Is configured.

  The first layer 64a is formed by spirally winding a long metal plate having a predetermined thickness clockwise from the front end to the rear end with a coil gap at a predetermined interval, and the front end is an exterior member It is being fixed to the outer peripheral surface of the fixing | fixed part 61c. The metal plate constituting the first layer 64a has a thickness of about 10 μm to 100 μm.

  The second layer 64b is formed by spirally winding the same metal flat plate as the first layer 64a counterclockwise from the front end to the rear end with a coil gap of a predetermined interval. The front end portion and the rear end portion of the second layer 64b are fixed to the first layer 64a fixed to the outer peripheral surface of the exterior member fixing portion 61c.

The third layer 64c is formed by spirally winding the same metal flat plate as the first layer 64a clockwise from the front end to the rear end with a coil gap of a predetermined interval, and the front end portion and the rear end portion Is fixed to the second layer 64b.
Since the first layer 64a, the second layer 64b, and the third layer 64c are spirally wound in the exterior member 64 configured in this manner, for example, the endoscope tube 21 (laser transmission path 60) is bent. Even in this case, bending can be accommodated by changing the coil gap. That is, the exterior member 64 has flexibility.

  In addition, the first layer 64a and the third layer 64c are spirally wound so that the first layer 64a and the third layer 64c are clockwise when viewed from the tip, and the second layer 64b sandwiched between the first layer 64a and the third layer 64c is It is wound counterclockwise.

  Thereby, when the rear end side of the exterior member 64 is rotated clockwise, the first layer 64a and the third layer 64c are tightened, and the clockwise torque can be transmitted to the tip end side of the exterior member 64. Similarly, when the rear end side of the exterior member 64 is rotated counterclockwise, the second layer 64 b is tightened, and counterclockwise torque can be transmitted to the tip end side of the exterior member 64.

  The outer layer tube 65 is made of a heat-shrinkable resin that is shrunk by the application of heat and has water resistance. As a result, the outer layer tube 65 can be formed in a thin film shape that matches the shape of the third layer 64c, and has waterproof properties, so the outer diameter of the laser transmission path 60 can be reduced.

  In the laser transmission path 60 configured in this manner, the outer peripheral surface of the hollow waveguide 62 and the inner peripheral surface of the water passage forming tube 63 are surrounded at a predetermined distance, and the hollow waveguide 62 and the water passage forming tube 63 And a first cooling channel 66 is formed therebetween. On the other hand, a second cooling water channel 67 through which the cooling water 57a flows is also formed at a predetermined interval between the water channel forming tube 63 and the first layer 64a. The first cooling water passage 66 and the second cooling water passage 67 are connected via a communication passage 68 formed of the exterior member fixing portion 61c, the hollow waveguide 62, and the first layer 64a.

  The rear end sides of the first cooling water passage 66 and the second cooling water passage 67 thus connected via the communication passage 68 are respectively connected to the cooling water discharge unit 57 illustrated in FIG. The cooling water 57a is supplied to the first cooling water passage 66 from 57, and the cooling water 57a flowing through the first cooling water passage 66 flows to the second cooling water passage 67 via the communication passage 68, and again to the cooling water discharge portion 57. It will be collected.

  The laser chip 70 that can be attached to the end of the laser transmission line 60 is, as shown in FIGS. 3, 4 and 6, a laser transmission line attachment 71 that can be screwed with the attachment 61, and a laser transmission line attachment 71 The contact portion 72 abuts on the living tissue on the tip end side of the head, and the connection portion 73 connecting a part of the contact portion 72 and the laser transmission path mounting portion 71.

  Briefly explaining the laser chip 70, the laser transmission path mounting portion 71 has a cylindrical shape having an outer diameter substantially the same as the outer diameter of the tube connection portion 61b and an inner diameter substantially the same as the inner diameter of the laser chip mounting portion 61a. It is formed of a body, and on the inner peripheral surface on the rear end side of the laser transmission path mounting portion 71, there is formed a screw groove that can be screwed with the screw thread 61d (see FIG. 6A)

The abutting portion 72 is a solid substantially cylindrical shape disposed at a predetermined distance from the laser transmission path mounting portion 71 on the tip end side of the laser transmission path mounting portion 71, and is more than the laser transmission path mounting portion 71. It is configured to be slightly smaller, and the tip is provided with an abutment surface 72a that abuts on a living tissue. The laser chip 70 including the contact portion 72 is made of stainless steel capable of absorbing the laser beam 56a emitted from the laser irradiation port 62b.
In the present embodiment, the laser chip 70 is made of stainless steel, but may be made of, for example, another metal or a heat resistant material such as ceramic as long as it can absorb the laser light 56a.

  The contact portion 72 is formed with a hook portion 72 b protruding toward the opening of the hollow waveguide 62, and the contact portion 72 is provided to face the laser irradiation port 62 b of the hollow waveguide 62. It is possible to prevent the laser beam 56a from penetrating to the tip.

  As shown in FIGS. 3 and 4, the connecting portion 73 connecting the laser transmission path mounting portion 71 and the contact portion 72 which are arranged at a predetermined interval is the laser transmission path mounting portion 71 and the contact portion 72. The lower part of the is connected.

If it explains in full detail, the section seen from the irradiation direction of a laser beam is formed in mountain shape in connection part 73. Further, the mucous membrane lower layer L2 can be hooked and held by the hooking portion 72b formed in the contact portion 72, and the laser beam 56a can be irradiated and cauterized, and the mucous membrane lower layer L2 can be cut.
The laser chip 70 configured as described above has a rotationally asymmetric shape with the irradiation direction of the laser beam 56a as a rotation axis.

Next, a hemostasis method used for endoscopic submucosal dissection (ESD) using the laser treatment system 1 will be described.
As described above, in the endoscopic submucosal dissection (ESD) using the laser treatment system 1, bleeding may occur by irradiation with the laser beam 56a. In such a case, the operator control unit 12 having the laser transmission path 60 with the laser chip 70 inserted therein is inserted into the device insertion path 19 into the body and imaged by the imaging unit 45 displayed by the image display unit 47 Based on the front image of the distal end forming unit 30, the distal end forming unit 30 of the operator operation unit 12 is inserted until the operation target site is reached. The operation target site is a lumen such as the esophagus or the stomach, and is an appropriate site of a living body including human.

  Then, the contact portion 72 is disposed at the bleeding portion while confirming the image of the image display portion 47, and the contact surface 72a heated by irradiating the laser light 56a conducting the conductive space 62a of the hollow waveguide 62 is bled. Hemostasis by contacting the site.

  In this case, by operating the cooling water discharge unit 57, the cooling water 57a can circulate through the first cooling water passage 66 and the first cooling water passage 66, and the hollow waveguide 62 heated by the laser beam 56a is cooled by the cooling water 57a. It can be cooled. In addition, since the first cooling water passage 66 is configured to be in contact with the outer peripheral surface of the heated hollow waveguide 62, the hollow waveguide 62 can be efficiently cooled by the cooling water 57a.

Further, the laser beam 56a uses a CO ₂ laser having a large absorption rate to water, and the cooling water 57a is supplied to the first cooling water passage 66 around the water passage forming tube 63, so by any chance a hollow waveguide Even if the laser beam 56a guiding the conduction space 62a is leaked (misirradiated) when the 62 is broken, the outer peripheral surface of the water passage forming tube 63 is surrounded by the exterior member 64, so the endoscope tube 21 is Can prevent the occurrence of damage. Therefore, a highly safe and reliable operator operation unit 12 can be configured.

Further, by attaching the laser chip 70 to the laser transmission path 60 of the present embodiment, it is possible to safely cut the tissue of the submucosa layer L2 in the vicinity of the diseased tissue T to be exfoliated.
The method will be briefly described below based on FIG.

  FIG. 7 is an explanatory view showing the cutting of the submucosal layer L2 using the laser chip 70. More specifically, FIG. 7A shows a state in which the laser chip 70 is disposed to the submucosal layer L2 to be cut. FIG. 7 (b) shows a schematic view of a state where the laser chip 70 is disposed in an appropriate direction with respect to the submucosal layer L2 to be cut, and FIG. The schematic of the state which arrange | positioned L2 and irradiated the laser beam 56a is shown.

  First, irradiation with the plural-point laser beam 56a is performed so as to surround the diseased tissue T, which is an object to be peeled off in the mucous membrane layer L1, and marks (markings) in a cutting range are made. Next, hyaluronic acid H is injected into the submucosal layer L2 below the affected tissue T to float the affected tissue T, and the laser beam 56a is irradiated along the affected tissue T to incise the mucosal layer L1 (FIG. 7). See (a)).

  Next, the laser transmission path 60 is removed from the device insertion port 20, the laser chip 70 is attached to the tip of the laser transmission path 60, and the laser transmission path 60 is inserted again into the device insertion port 20. In this case, the arrangement direction of the laser chip 70 is not necessarily arranged in the desired direction, and as shown in FIG. 7A, the diseased tissue T to be cut is brought into contact with the laser transmission path mounting portion 71. It may be arranged in the direction which can not be arranged between the parts 72.

  On the other hand, by rotating the rear end side of the laser transmission path 60 with the laser irradiation direction as the rotation axis, as shown in FIG. 7B, the laser chip 70 is rotated so as to be disposed in a desired direction. It can be done. And as shown in FIG.7 (c), while making the contact part 72 insert along the incised mucous membrane layer L1, the submucosa L2 is hold | maintained to the hook part 72b shown in FIG. 4 using the connection part 73. The laser beam 56a can be cut off by irradiating the laser beam 56a.

  Thus, the tissue of the submucosal layer L2 is tensioned by moving the laser chip 70 so as to cut the laser chip 70 while holding the submucosal layer L2 at the hooking portion 72b as shown in FIG. 4 and irradiating the laser light 56a. The tissue of the submucosal layer L2 can be cut while being irradiated with the laser beam 56a in the state. Therefore, the affected area tissue T can be easily cut away from the surrounding submucosal layer L2, and the affected area tissue T can be separated.

  In this manner, the hollow waveguide 62 for guiding the laser beam 56a, and the package member made of a metal flat plate fixed so as to be integrated with the hollow waveguide 62 and surrounding the outer periphery of the hollow waveguide 62 64 and a laser chip mounting portion 61a to which the laser chip 70 provided on one end side of the hollow waveguide 62 is attached, and the exterior member 64 is formed in a multilayer structure having flexibility, and the other end The laser transmission path 60 formed of a cylindrical torque transmission body for transmitting the torque on the side to the tip side can reduce its outer diameter.

  More specifically, the outer diameter of the outer member 64 corresponding to the thickness of the metal plate is a laser by forming the outer member 64 made of a flat metal with a multilayer structure and surrounding the outer periphery of the hollow waveguide 62 It serves as the outer diameter of the transmission line 60. That is, since the outer diameter of the laser transmission line 60 depends on the thickness of the exterior member 64, the diameter of the laser transmission line 60 can be reduced.

  In addition, even if the hollow waveguide 62 is damaged, since the exterior member 64 surrounding the outer periphery of the hollow waveguide 62 is made of metal forming a multilayer structure, the laser beam leaked from the damaged portion 56a is blocked by the exterior member 64, and it is possible to prevent the laser transmission path 60 from leaking outside.

  Furthermore, since the exterior member 64 is fixed so as to be integrated with the hollow waveguide 62, the rotation on the other end side of the exterior member 64 can be transmitted to one end side. Therefore, one end side of the hollow waveguide 62 can be rotated by a desired amount of rotation, and one end side of the hollow waveguide 62 can be finely adjusted in the circumferential direction and positioned.

  Thus, as in the case where the laser chip 70 is mounted on the mounting portion 61, by rotating the other end side, it is possible to follow and rotate one end side of the exterior member 64 formed of a torque transfer member. The position of the laser chip 70 can be finely adjusted in the circumferential direction. Therefore, the arrangement of the laser chip 70 can be adjusted to be in the desired direction.

  In addition, a first layer 64a covering the outer periphery of the hollow waveguide 62 in a spiral shape and covering the outer member 64, and a second spiral formed by winding the outer periphery of the first layer 64a in the opposite direction to the first layer 64a. By comprising the layer 64b, the torque by the rotation operation performed on the rear end side of the laser transmission path 60 can be reliably and accurately transmitted to the front end side.

  For example, when the laser transmission path 60 is rotated in the same positive direction as the direction in which the first layer 64 a is wound on the rear end side of the laser transmission path 60, the first layer 64 a is tightened with respect to the hollow waveguide 62. Therefore, the torque in the positive direction can be transmitted to the tip of the laser transmission path 60.

  On the other hand, when the laser transmission path 60 is rotated in the direction opposite to the winding direction of the first layer 64 a on the rear end side of the laser transmission path 60, the first layer 64 a is loosened with respect to the hollow waveguide 62 However, since the second layer 64b is clamped to the hollow waveguide 62, torque in the reverse direction can be transmitted to the tip of the laser transmission line 60. For this reason, the torque by the rotation operation performed on the rear end side of the laser transmission path 60 can be reliably transmitted to the front end side.

  Furthermore, the laser transmission path 60 is inserted into the device insertion path 19 provided in the endoscope by enclosing the outer peripheral surface of the exterior member 64 with the outer layer tube 65 made of a resin that has both water repellency and slipperiness. In this case, the laser transmission path 60 can be smoothly inserted into the device insertion path without kinking, and the device insertion path 19 can be prevented from being damaged.

  More specifically, since the exterior member 64 is surrounded by the outer layer tube 65 made of resin, the outer diameter of the exterior member 64 can be prevented from expanding, and the outer layer tube can be interposed between the metal exterior member 64 and the device insertion path 19. By providing 65, the outer layer tube 65 can prevent the exterior member 64 and the laser transmission path 60 from being caught. Therefore, the laser transmission path 60 can be smoothly inserted into the device insertion path 19, and the exterior member 64 can be prevented from damaging the device insertion path 19.

  In addition, since the outer layer tube 65 is waterproof, it is possible to prevent the liquid such as body fluid and blood from entering the inside of the exterior member 64 from the outside. Thereby, the exterior member 64 can prevent the inside from being corroded or contaminated by such intruding liquid.

  Furthermore, by enclosing the outer peripheral surface of the exterior member 64 with the outer layer tube 65, the outer layer tube 65 suppresses deformation of the exterior member 64 even if the hollow waveguide 62 is damaged, so that it is possible to more reliably The laser beam 56a can be prevented from leaking to the outside.

  In addition, by forming the outer layer tube 65 with a heat-shrinkable tube that contracts due to heating, the exterior member 64 can be easily surrounded by the outer layer tube 65, and the thickness of the outer layer tube 65 can be reduced. While reducing the diameter of the laser transmission path 60.

  Further, the first cooling water passage 66 for circulating the cooling water 57a along the hollow waveguide 62 is provided between the hollow waveguide 62 and the exterior member 64, so that the hollow waveguide 62 heated by the laser beam 56a. Can be cooled by the cooling water 57 a flowing in the first cooling water passage 66. Therefore, the durability of the laser transmission path 60 capable of reliably treating the treatment target site with the laser beam 56a can be improved.

  Furthermore, it is comprised by the 1st cooling water channel 66 and the 2nd cooling water channel 67 which were formed along the hollow waveguide 62, and the communication channel 68 which connects the 1st cooling water channel 66 and the 2nd cooling water channel 67 in one end side. Since the cooling water 57a which has flowed through one of the first cooling water passage 66 or the second cooling water passage 67 can flow to the other through the communication passage 68, the cooling water 57a can be recovered. Therefore, the cooling water 57a can be circulated to efficiently cool the hollow waveguide 62 heated by the laser beam 56a. In addition, the cooling water 57a can be circulated in the first cooling water passage 66 or the second cooling water passage 67 without the cooling water 57a leaking to the operation target site.

In correspondence with the configuration of the present invention and the above-described embodiment, the light guide member of the present invention corresponds to the hollow waveguide 62 and, similarly,
The mounting portion corresponds to the laser chip mounting portion 61a,
The torque transfer body corresponds to the exterior member 64,
The outer layer protection member corresponds to the outer layer tube 65,
The cooling medium corresponds to the cooling water 57a,
The cooling channel corresponds to the first cooling channel 66 and the second cooling channel 67,
The laser oscillator corresponds to the laser oscillator 56,
The laser treatment device corresponds to the laser treatment device 50,
The endoscope corresponds to the endoscope apparatus 10, but
The present invention is not limited to the configuration of the above-described embodiment, and many embodiments can be obtained.

Further, the laser beam 56a uses a CO ₂ laser having a large absorption coefficient to water, and the cooling water 57a is supplied to the first cooling water passage 66 around the hollow waveguide 62. Therefore, the hollow waveguide should be Even if the laser beam 56a guiding the conduction space 62a is leaked (misirradiated) when 62 is broken, occurrence of damage to the outer layer tube 65 or the endoscope tube 21 due to the erroneous irradiation of the laser beam 56a It can prevent. Therefore, a highly safe and reliable operator operation unit 12 can be configured.

  Furthermore, the cooling water 57a is supplied from the cooling water discharge unit 57, passes through the first cooling water passage 66, the communication passage 68, and the second cooling water passage 67, and is recovered by the cooling water discharge unit 57, that is, the cooling water 57a. May be, for example, distilled water or tap water in order to circulate without leaking outside.

  Further, in the present embodiment, the laser chip 70 has a rotationally asymmetric shape with the irradiation direction of the laser beam 56a as the rotation axis, but the shape of the laser chip 70 does not necessarily have to be rotationally asymmetric. For example, as shown in FIG. In addition, a rotationally symmetric bullet-shaped hemostatic laser tip 70x may be used.

  Furthermore, in the present embodiment, the laser chip 70 holds the submucosal layer L2 between the laser transmission path mounting portion 71 and the contact portion 72 and can directly irradiate the laser beam 56a. As shown in FIG. 9, the laser chip 70y may have a configuration in which the hemostatic portion 74 is provided below the contact portion 72. As a result, the laser beam 56a is irradiated to the laser chip 70y to heat the hemostasis part 74, whereby hemostasis can be achieved.

  Furthermore, the configuration may be such that the laser beam 56a is directly irradiated to the submucosal layer L2 without mounting the laser chip 70 on the mounting unit 61. When the laser chip 70 is not attached to the attachment portion 61, the configuration of the attachment portion 61 can be appropriately changed to a corresponding configuration.

  Further, in the present embodiment, the first layer 64a and the water channel forming tube 63 are separated by a predetermined distance and the second layer 64b is fixed, but such a configuration is not necessarily required. For example, as shown in FIG. 10, the first layer 64a and the water channel forming tube 63 may be fixed and the first layer 64a may not be in close contact with the second layer 64b.

Here, FIG. 10 shows an explanatory view of a laser transmission line 60z in another embodiment. More specifically, FIG. 10 (a) shows a cross-sectional view corresponding to the cross section AA in FIG. 3, and FIG. 10 (b) shows a cross-sectional view CC in FIG. 10 (a).
In the laser transmission line 60z, the same components as those of the laser transmission line 60 are denoted by the same reference numerals and the description thereof will be omitted.

  Specifically, according to the example of FIG. 10, the first layer 64a surrounds the outer peripheral surface of the water channel forming tube 63 connected to the hollow waveguide 62 by the connecting portions 69 provided on the upper side and the lower side of the tip side. Is configured. For this reason, the first layer 64 a is indirectly fixed to the mounting portion 61 via the hollow waveguide 62.

  By this configuration, when the rear end side of the exterior member 64 is rotated, for example, clockwise, the first layer 64a and the third layer 64c are narrowed toward the inner diameter side, and the mounting portion 61 is rotated clockwise. be able to. On the other hand, since the second layer 64b loosens in the direction in which the second layer 64b spreads to the outer diameter side, the second cooling water channel 67 through which the cooling water 57a flows from the front end to the rear end is secured.

  On the other hand, when the rear end side of the exterior member 64 is rotated counterclockwise, the mounting portion 61 can be rotated counterclockwise because the second layer 64b is narrowed toward the inner diameter side. At this time, although the second layer 64b is narrowed to the inner diameter side, since the second layer 64b and the third layer 64c are fixed, the second cooling water channel 67 through which the cooling water 57a flows from the front end to the rear end Will be secured.

  As described above, in the embodiment shown in FIG. 10, since the outer periphery of the water passage forming tube 63 is surrounded by the first layer 64a, the thickness of the outermost layer can be reduced and the second cooling path can be reliably ensured. Therefore, the hollow waveguide 62 can be cooled while reducing the overall outer diameter of the laser transmission path 60z.

  Furthermore, in the present embodiment, the first layer 64a, the second layer 64b, and the third layer 64c are wound with a predetermined coil gap so as to be planar along the hollow waveguide 62. For example, the first layer 64a, the second layer 64b, and the third layer 64c may be wound so as to partially overlap with the front and back in the longitudinal direction of the hollow waveguide 62, respectively.

  Thereby, for example, even when the hollow waveguide 62 is broken, it is possible to reliably prevent the laser light 56a from leaking. Further, since the leakage of the laser beam 56a can be surely prevented, it is not necessary to form the outer layer member into three layers, and the outer layer member may be formed into two layers.

DESCRIPTION OF SYMBOLS 1 laser treatment system 10 endoscope apparatus 50 laser treatment apparatus 56 laser oscillation part 56a laser beam 57a cooling water 60 laser transmission path 61a laser chip mounting part 62 hollow waveguide 64 exterior member 64a first layer 64b second layer 65 outer layer tube 66 first cooling water channel 67 second cooling water channel 68 communicating part 70 laser tip 80 laser treatment tool

Claims (10)

A light guide member for guiding laser light;
An exterior member made of a metallic flat plate fixed so as to be integrated with the light guide member and surrounding the outer periphery of the light guide member;
And a mounting portion provided on one end side of the light guide member to which the laser chip is mounted,
The exterior member is
A laser transmission line which is formed of a flexible multi-layer structure and is formed of a cylindrical torque transmission body which transmits torque on the other end side to the tip side. The exterior member is
A first layer spirally covering an outer periphery of the light guide member;
The laser transmission line according to claim 1, wherein the outer periphery of the first layer is constituted by a spiral second layer wound in the opposite direction to the first layer. The laser transmission path according to claim 1 or claim 2, wherein the outer circumferential surface of the exterior member is surrounded by a resin outer layer protecting member having water proofness. The laser transmission line according to claim 3, wherein the outer layer protection member is formed of a heat-shrinkable tube that shrinks by heating. The laser transmission line according to any one of claims 1 to 4, wherein a cooling path for circulating a cooling medium along the light guide member is provided between the light guide member and the exterior member. The cooling path includes a first cooling path and a second cooling path formed along the light guide member,
The laser transmission line according to claim 5, further comprising: a communicating portion communicating the first cooling path with the second cooling path at one end side. A laser transmission line according to any one of claims 1 to 6;
A laser treatment tool comprising: a laser chip attached to the attachment portion in the laser transmission path. The laser treatment tool according to claim 7, wherein the laser chip is configured in a rotationally asymmetric shape. A laser treatment tool according to claim 7 or 8;
The laser treatment apparatus comprised with the laser oscillator which oscillates a carbon dioxide gas laser beam connected to the other end of the said laser transmission line. A laser treatment device according to claim 9;
The laser treatment system comprised with the endoscope which enabled penetration of the said laser transmission line.

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