JP5469115B2 - Double overtube - Google Patents

Description

  The present invention relates to an overtube used with an endoscope, and more particularly, to a double overtube having two overtubes.

  Endoscopic submucosal dissection (ESD) using an endoscope is formed on the endoscope while checking the image of the operative field taken by the endoscope on the display screen. A treatment for a diseased piece is performed using a treatment tool that is sent out from the endoscope tip through a treatment tool channel. Depending on the position of the lesion, it may be easier to advance the procedure by approaching the endoscope tip perpendicularly to the lesion, or it may be easier to proceed by approaching the endoscope horizontally. It ’s not easy to guide. In addition, it is necessary to proceed with the procedure while maintaining a good visual field by securing an appropriate distance between the diseased piece and the endoscope tip. In addition, when incising a diseased piece using a scalpel (knife) as a treatment tool, the tissue to be incised may move with the movement of the scalpel, and the incision of the diseased part may not be successful. At present, traction is applied in the direction opposite to the moving direction of the knife by manipulating the direction of the distal end of the endoscope or changing the posture of the patient.

  Japanese Patent Application Laid-Open No. H10-228867 describes a technique in which a balloon provided at an insertion portion of an endoscope is inflated to separate the endoscope insertion portion from the heart surface. In Patent Document 2, a distal balloon is provided at the distal end portion of the probe, and a proximal balloon that is movable toward the proximal end is provided, and the optical balloon and the surface of the body cavity tissue are stably positioned by the distal balloon and the proximal probe. Is described. However, it does not take into account the ease with which the procedure for the disease can be performed.

JP 2010-284503 A JP 2010-125274 A

  An object of the present invention is to facilitate a procedure for a diseased piece in ESD.

  The double overtube according to the present invention is provided with a balloon that can be inflated and contracted on the outer surface of the distal end, a cylindrical inner overtube into which the endoscope insertion portion is inserted, and a balloon that can be inflated and contracted on the outer surface of the distal end. Provided with a cylindrical outer overtube into which the inner overtube is inserted. The distal end portion of the endoscope insertion portion is located on the distal side of the inner overtube where the balloon is provided. An endoscope passage window having a size capable of passing through is formed.

  The endoscope insertion portion is inserted into the inner overtube, and the inner overtube is inserted into the outer overtube. The endoscope insertion portion is covered with the inner overtube and the outer overtube in a double manner and inserted up to the diseased part. At this time, the balloons provided at the tip of the inner overtube and the tip of the outer overtube are both deflated. Stop the insertion of the inner overtube, outer overtube, and endoscope insertion part before the disease site (insertion side) and inflate the balloon at the tip of the outer overtube. The balloon is pressed against the inner lumen wall (for example, the intestinal wall of the large intestine), thereby fixing the outer overtube within the lumen. Next, the inner overtube is further inserted so that the tip of the inner overtube reaches the back of the diseased part, and the balloon at the tip of the inner overtube is inflated there. The inner overtube is fixed in the lumen, whereby the diseased part is sandwiched between the balloon at the tip of the inner overtube and the balloon at the tip of the outer overtube. If the inner overtube is pushed in slightly further or the outer overtube is pulled slightly while the two balloons are inflated, a tensile force can be applied to the surface tissue of the lumen between the two balloons. . The surface tissue including the lesion site can be easily excised with a scalpel, a knife or the like.

  When only the inner overtube is inserted into the body with the outer overtube fixed as described above, an endoscope passage window formed on the distal side of the inner overtube where the balloon is provided is provided. , Go out of the outer overtube. Through this endoscope passage window, the endoscope distal end portion (further, the endoscope treatment tool protruding from the endoscope distal end portion) can be taken out of the inner overtube. Treatment (resection, etc.) for a diseased part can be performed using an endoscope treatment tool.

  In one embodiment, the balloon provided on the inner overtube is provided over the entire circumference of the distal end portion of the inner overtube, and the balloon provided on the outer overtube is also disposed on the entire distal end portion of the outer overtube. It is provided over the circumference. With the two balloons, the distal end portion of the inner overtube and the distal end portion of the outer overtube can be separated from the body surface tissue over the entire circumference.

  Preferably, the balloon provided on the inner overtube and the balloon provided on the outer overtube are likely to swell on the same side as the endoscope passage window formed on the inner tube. Since the space between the endoscope passage window and the body surface tissue is widened, it is possible to easily approach the diseased piece from the horizontal direction or the vertical direction.

It is a perspective view which shows a double overtube and an endoscope insertion part. This shows the ESD implementation process and shows how the double overtube is inserted. This shows the ESD implementation process and shows how the double overtube is inserted. This shows the ESD implementation process and shows how the double overtube is inserted. It is a cross-sectional view showing the positional relationship between the double overtube and the balloon.

  FIG. 1 is a perspective view showing an endoscope kit. The endoscope kit of this embodiment is composed of an endoscope and a double overtube. The double overtube includes a cylindrical inner overtube (hereinafter referred to as an inner tube) 10 and a cylindrical outer overtube (referred to as an outer tube) 20. FIG. 1 shows the insertion portion 30 of the endoscope, the distal end portion of the inner tube 10, and the distal end portion of the outer tube 20.

  The endoscope insertion portion 30 has an appearance that is elongated in its entirety, and almost the whole has flexibility. Further, the distal end portion of the endoscope insertion portion 30 is continuous with an endoscope operation portion (not shown). Using the angle knob provided in the endoscope operation section, the vicinity of the distal end portion of the endoscope insertion section 30 can be bent up and down and left and right.

  The distal end surface of the endoscope insertion section 30 is provided with an opening (exit) of the treatment instrument channel 31, an observation window 32 of the imaging optical system, and light irradiation ports 33L and 33R provided on both sides of the observation window 32, respectively. It has been. The treatment instrument channel 31 is formed throughout the endoscope insertion section 30 and extends to a treatment instrument insertion port (not shown) of the endoscope operation section. The treatment instrument inserted from the treatment instrument insertion port passes through the treatment instrument channel 31 and reaches the distal end of the endoscope insertion portion 30. An imaging device (not shown) including an imaging element is provided inside the observation window 32 (inside the distal end portion of the endoscope insertion portion). The imaging device is connected to a signal cable (not shown) extending over the entire endoscope insertion portion 30, and image data captured by the imaging device through the observation window 32 is given to the image processing device (not shown) through the signal cable. The captured image is displayed. The tip of an optical fiber (not shown) extending over the entire endoscope insertion portion 30 is located inside the light irradiation ports 33L and 33R, and light transmitted through the optical fiber is transmitted from the light irradiation ports 33L and 33R. Emitted.

  The inner tube 10 and the outer tube 20 are both cylindrical and are made of a flexible material such as polyurethane. The diameter of the insertion conduit 14 formed by the inner peripheral surface of the inner tube 10 (inner diameter of the inner tube 10) is slightly larger than the cross-sectional diameter of the endoscope insertion portion 30, and is within the insertion conduit 14 of the inner tube 10. The endoscope insertion portion 30 can be passed through in such a manner as to be able to advance and retreat. The diameter of the insertion conduit 24 constituted by the inner peripheral surface of the outer tube 20 (the inner diameter of the outer tube 20) is slightly larger than the outer diameter of the inner tube 10, and the inner tube 10 Can be passed forward and backward.

  Balloons 11 and 21 made of, for example, natural rubber are inflated on the outer peripheral surface of the distal end portion of the inner tube 10 and the outer peripheral surface of the distal end portion of the outer tube 20 by expanding air and contracting by extracting air. They are provided (fixed) over the entire circumference of the tube 10 and the outer tube 20, respectively. Air holes 12 and 22 are formed in the outer peripheral surface of the distal end portion of the inner tube 10 and the outer peripheral surface of the distal end portion of the outer tube 20, respectively. These air holes 12 and 22 are formed in the inner tube 10 and the outer tube 20, respectively. It continues to an air supply pipe (not shown) formed in the longitudinal direction at a position close to the outer peripheral surface. The balloons 11 and 21 at the distal end of the inner tube 10 and the distal end of the outer tube 20 can be independently inflated and deflated by introducing air through the air feeding tube or drawing air through the air feeding tube. be able to. FIG. 1 shows a state where both of the two balloons 11 and 21 are inflated.

  An endoscope passage window 13 is opened on the distal side of the distal end portion where the balloon 11 of the inner tube 10 is provided. As will be described later, the distal end portion of the endoscope insertion portion 30 inserted into the inner tube 10 can be taken out of the inner tube 10 through the endoscope passage window 13 formed in the inner tube 10.

  The endoscope insertion portion 30 is inserted into the insertion conduit 14 of the inner tube 10 from the distal end portion. The inner tube 10 in which the endoscope insertion portion 30 is inserted is inserted into the insertion conduit 24 of the outer tube 20 from the distal end portion. The endoscope insertion portion 30 is inserted from the patient's oral cavity or nasal cavity while being double-covered by the inner tube 10 and the outer tube 20, and is sent to the duodenum through the larynx, pharynx, and esophagus. It can also be inserted through the patient's anus and fed into the large intestine. In any case, the endoscope insertion portion 30 is covered with the inner tube 10 and the outer tube 20 and is sent into the patient's body.

  FIGS. 2 to 4 show the process of performing ESD (Endoscopic Submucosal Dissection) on the diseased K.

  The end portion of the endoscope insertion portion 30 and the end portion of the inner tube 10 are fixed on the endoscope operation portion side (external), and the end portion of the inner tube 10 and the end portion of the outer tube 20 are also operated by the endoscope. Fixed on the side. The inner tube 10, the outer tube 20, and the endoscope insertion portion 30 are integrally fed into the body. When the inner tube 10, the outer tube 20, and the endoscope insertion portion 30 are inserted into the body, the inside of the body is imaged by the imaging device provided at the distal end of the endoscope insertion portion 30, and the in-vivo image is the image described above. It is displayed on a display device connected to the processing device. The surgeon or his assistant sends the inner tube 10, the outer tube 20, and the endoscope insertion portion 30 to the vicinity of the diseased piece K while checking the in-vivo images displayed on the display device. At this time, the balloons 11 and 21 of the inner tube 10 and the outer tube 20 are both in a contracted state.

  When the disease K is confirmed, the insertion of the inner tube 10, the outer tube 20, and the endoscope insertion portion 30 is stopped, and the end portion of the inner tube 10 and the end portion of the outer tube 20 are stopped on the endoscope operation portion side. Fixing and fixing of the end portion of the inner tube 10 and the end portion of the endoscope insertion portion 30 are released. Then, air is sent to the balloon 21 provided at the distal end portion of the outer tube 20, and the balloon 21 is inflated. The balloon 21 is pressed against the lumen (for example, the inner wall of the intestine), whereby the distal end portion of the outer tube 20 is fixed in the lumen. The distal end of the outer tube 20 and the distal end of the endoscope insertion portion 30 are positioned on the front side (endoscope insertion side) of the diseased piece K. Thereafter, only the inner tube 10 is further inserted into the back of the diseased piece K (FIG. 2).

  The inner tube 10 is inserted to the back of the diseased piece K, and the endoscope passing window 13 opened in the peripheral surface of the inner tube 10 is positioned on the diseased piece K. Air is sent to the balloon 11 provided at the tip of the inner tube 10, and the balloon 11 is inflated. The balloon 11 is pressed against the lumen, whereby the distal end portion of the inner tube 10 is fixed in the lumen (FIG. 3).

  With the diseased piece K sandwiched between the two balloons 11 and 21, the inner tube 10 is pushed in slightly or the outer tube 20 is pulled slightly. Then, the body tissue surface (for example, the intestinal tract) in the lumen between the balloons 11 and 21 is stretched (pulled), and an appropriate tensile force is applied to the tissue surface in the range.

  Next, the endoscope insertion portion 30 is operated to project the distal end portion of the endoscope insertion portion 30 from the endoscope passage window 13 opened in the inner tube 10. Further, a treatment instrument (for example, a high-frequency knife, a knife, etc.) 35 is projected from the distal end of the endoscope insertion portion 30 through the treatment instrument channel 31 (see FIG. 1). The treatment tool 35 performs excision of the disease piece K or the like. As described above, since a tensile force is applied to the tissue surface including the diseased piece K, the tissue surface is prevented from moving with the movement of the knife or the like, and the tissue is incised using a knife or the like. A natural cut can be made (FIG. 4).

  FIG. 5 is a cross-sectional view of the inner tube 10 and the outer tube 20 inserted into the lumen. In FIG. 5, the illustration of the endoscope insertion portion 30 is omitted.

  The two balloons 11 and 21 may be inflated evenly (equal distance) in the radial direction around the outer periphery of the inner tube 10 and the outer tube 20, or as shown in FIG. The same side (lower side in FIG. 5) as the opened endoscope passage window 13 may be more likely to swell. For example, the wall thickness in the same side as the endoscope passage window 13 of the balloons 11 and 21 is made thinner than the wall thickness in the other ranges. As a result, the balloons 11 and 21 are greatly inflated toward the endoscope passage window 13 side. Since the interval between the endoscope passage window 13 opened in the inner tube 10 and the body tissue surface (sickness K) is widened, the treatment tool 35 makes it easy to approach the sickness K from the vertical direction, for example. (See FIG. 4).

10 Inner over tube
11, 21 balloon
13 Endoscope passage window
14, 24 Intubation tube
20 Outer over tube
30 Endoscope insertion part
35 treatment tool

Claims (3)

A cylindrical inner overtube in which an inflatable and defensible balloon is provided on the outer surface of the distal end portion, and an endoscope insertion portion is inserted therein;
A balloon that can be inflated and deflated is provided on the outer surface of the tip portion, and includes a cylindrical outer overtube into which the inner overtube is inserted.
An endoscope passage window having a size through which the distal end portion of the endoscope insertion portion can pass is formed on the distal side of the inner overtube where the balloon is provided. ,
Double over tube. The balloon provided on the inner overtube is provided over the entire circumference of the distal end portion of the inner overtube, and the balloon provided on the outer overtube is provided over the entire circumference of the distal end portion of the outer overtube. Is,
The double overtube according to claim 1. The balloon provided in the inner overtube and the balloon provided in the outer overtube are apt to swell on the same side as the endoscope passage window opened in the inner tube.
The double overtube according to claim 2.

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