JP5784972B2 - Exterior tube, laser transmission path, laser treatment instrument - Google Patents

Description

  The present invention relates to, for example, a laser treatment instrument for performing laser treatment, a laser transmission path inserted through the laser treatment instrument, and an outer tube constituting the laser transmission path.

  Conventionally, a treatment method using an endoscope has been implemented as a treatment method that can be treated with less burden on the patient. In the treatment using this endoscope, the endoscope tube is inserted into the body from the oral cavity or the like, and imaging and treatment are performed using the distal end configuration portion of the endoscope tube.

  The imaging is performed by irradiating illumination light from the tip component, receiving reflected light from the tissue in the body with a lens provided in the tip component, transmitting the light from the endoscope tube to the endoscope body device, This is executed by the endoscope main unit imaged and displayed on the display device. Alternatively, imaging is performed by an imaging element such as a CCD sensor provided at the distal end configuration portion of the endoscope tube, and an image signal configured by the distal end configuration portion is transmitted to the endoscope main body device through the endoscope tube. The image is displayed on the display device.

  The treatment is performed by a forceps tip that is inserted from a forceps insertion opening called a channel and comes out from the forceps outlet of the tip constituting portion. As the forceps, various instruments such as a gripping forceps and a knife are used.

In ablation surgery using therapeutic lasers, especially endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), the treatment space is expanded and smoke is used to secure a visual field. It is required to be removed.
For example, Patent Document 1 proposes a body cavity pressure adjusting device for a laser treatment apparatus in which a suction tube is communicated with a gap between a protective pipe of a laser transmission fiber and a forceps channel, and the gap is used as a suction channel. Yes.
Patent Document 2 proposes a medical treatment instrument that is used in combination with an endoscope in which a flow path for a supply fluid or a suction fluid is provided between the outer periphery of the insertion portion and the inner periphery of the sheath.

  As described above, ablation surgery using a therapeutic laser, in particular, a laser transmission path used for ESD or EMR, requires various functions such as water injection, assist gas injection, and cooling of a hollow waveguide. The cross-sectional structure is complicated, and the diameter is larger than that of the conventional laser transmission path.

  Since the laser transmission path is thus increased in diameter, it is described in Patent Documents 1 and 2 for inhaling smoke in ESD or EMR while being inserted through the transmission path insertion hole in the endoscope external hose. This structure could not be used.

Japanese Patent Laid-Open No. 62-148675 JP 2006-341066 A

  In view of the above-described problems, the present invention provides a laser treatment instrument capable of inhaling smoke in ESD or EMR, a laser transmission path inserted through the laser treatment instrument, and an outer tube constituting the laser transmission path. For the purpose.

The present invention constitutes a laser transmission path inserted into a transmission path insertion hole in an endoscope external hose together with a hollow waveguide formed in a long hollow shape for guiding laser light, and an internal insertion hole And an outer tube that allows the hollow waveguide to pass therethrough, and the protruding tip abuts the inner surface of the transmission path insertion hole on the outer surface in at least two directions in a cross section when inserted into the transmission path insertion hole. A protrusion that protrudes radially outward, and a gap forming portion that forms a gap between the adjacent protrusions and the inner surface of the transmission path insertion hole, and the outer surface and the inner surface of the insertion hole It is characterized in that a fluid conduit is provided in the interior of the space .

The hollow waveguide is formed of a tubular member made of a material having a high surface smoothness such as glass, a reflective film such as silver is formed on the inner wall of the tubular member, and a cyclic olefin polymer or polyimide is formed on the inner surface of the reflective film. It can be set as the pipe line which forms a dielectric thin film with a material with high transmission efficiency, such as.
The outer tube of the present invention constitutes a laser transmission path, and the laser transmission path constituted of the outer tube is inserted into the transmission path insertion hole in the endoscope external hose constituting the laser treatment instrument, so that the gap forming portion causes smoke. In the cauterization operation using laser light, especially ESD and EMR, the space to be treated can be expanded and the visual field can be secured. Therefore, reliable and safe treatment can be performed.

  Further, by inserting the laser transmission path constituted by the outer tube of the present invention into the transmission path insertion hole in the endoscope external hose constituting the laser treatment instrument, it can be positioned at the center in the transmission path insertion hole.

  As an aspect of the present invention, a plurality of irregularities can be formed in a cross-sectional gear shape continuously arranged in the circumferential direction, and the protrusions and the gap forming portions can be configured by the irregularities. In addition, the unevenness | corrugation not only the unevenness | corrugation comprised by a vertex and a side but the unevenness | corrugation comprised by a curve may be sufficient as the said unevenness | corrugation.

  According to the present invention, the laser transmission path constituted by the outer tube of the present invention can be more reliably positioned at the center of the transmission path insertion hole, and smoke can be generated by the concave gap forming portion formed in the circumferential direction. Can be aspirated.

  Moreover, as an aspect of this invention, while forming in a cross-sectional polygonal shape, while forming the said protrusion part in the vertex part of the said polygonal shape, the said clearance gap formation part can be comprised in the said polygonal side part.

  The cross-sectional polygonal shape is a concept including not only a polygonal shape constituted by vertices and sides such as a triangular shape and a quadrangular shape, but also a substantially polygonal shape constituted by a curve having an inflection point.

  According to the present invention, the laser transmission path configured by the outer tube of the present invention can be more reliably positioned at the center of the transmission path insertion hole, and the gap forming portion configured by the side portion of the polygonal shape allows the smoke transmission Can be aspirated.

  Further, as an aspect of the present invention, the elliptical cross section is formed, the projecting portion is configured by the elliptical arc portion on the major axis side, and the gap forming portion is configured by the elliptical minor axis side arc portion. can do.

  According to the present invention, the laser transmission path configured by the outer tube of the present invention can be positioned at the center of the transmission path insertion hole, and smoke is generated by the gap forming section configured by an elliptical short-axis arc portion. Can be aspirated.

As an aspect of the present invention, a fluid conduit may be provided between the hollow waveguide inserted into the insertion hole and the inner surface of the insertion hole.
By configuring the laser transmission path with the exterior tube of the present invention, it is possible to configure a laser transmission path capable of conducting a fluid such as cooling water to the fluid conduit.

  Specifically, a fluid conduit is provided between the hollow waveguide that is inserted into the insertion hole and the inner surface of the insertion hole, so that, for example, cooling water is conducted to the fluid conduit and is heated by laser light. It is possible to perform the treatment more reliably and safely by allowing a desired fluid to pass through the fluid pipe line such as cooling the hollow waveguide formed.

  In addition, the present invention is a laser transmission path in which the hollow waveguide is inserted into the insertion hole in the outer tube described above.

  According to the present invention, smoke can be inhaled by the gap forming portion, and the treatment target site can be reliably treated with laser light.

Furthermore, the present invention includes a laser generation source, a laser control unit, and the laser transmission path described above, and the distal end portion of the laser transmission path is positioned near the distal end opening of the endoscope external hose. In the endoscope external hose, a fluid suction means is connected to the gap forming portion to form a fluid suction conduit in the gap forming portion.
Thereby, the front-end | tip part of the laser transmission path which irradiates a laser beam can be reliably conducted to a treatment object site | part.

As an aspect of the present invention, the laser beam can be constituted by a carbon dioxide laser.
According to the present invention, smoke can be inhaled by the gap forming portion to safely treat the site to be treated. Specifically, as a laser beam, a carbon dioxide gas laser having high water absorbability and high biological surface absorbability is used in a bright field, so that the minimum necessary laser can be irradiated and the treatment target site can be safely treated. it can.

  According to the present invention, in view of the above-described problems, a laser treatment instrument capable of inhaling smoke in ESD or EMR, a laser transmission path inserted into the laser treatment instrument, and an outer tube constituting the laser transmission path are provided. be able to.

The schematic block diagram of the laser 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. Explanatory drawing by the perspective view for demonstrating the structure of an operator operation unit. Explanatory drawing by the perspective view for demonstrating the structure of a laser transmission path. Explanatory drawing by sectional drawing of a laser transmission path. Explanatory drawing by sectional drawing of the laser transmission path of another embodiment.

An embodiment of the present invention will be described below with reference to the drawings.
FIG. 1 is a configuration diagram illustrating a schematic configuration of a laser treatment system 1 including an endoscope apparatus 10 and a laser treatment apparatus 50, and FIG. 2 illustrates a configuration of the endoscope apparatus 10 and the laser treatment apparatus 50. FIG.

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

The operation unit 13 includes an eyepiece unit 15, an upper / lower angle knob 16, a left / right angle knob 17, an operation button 18, and a forceps insertion port 20.
The operation button 18 accepts operation inputs such as water supply, suction, zoom, or assist gas supply to be described later, water injection of affected area treatment water, and cooling water circulation.

  The endoscope tube 21 corresponding to the endoscope external hose is provided with a flexible tube portion 22, a curved tube portion 23, and a distal end configuration portion 30 in this order from the base portion toward the distal end. In addition, a forceps insertion path 19 that communicates from the forceps insertion opening 20 to the forceps outlet 36 of the distal end component 30 and that corresponds to the transmission path insertion hole is provided inside the endoscope tube 21. The forceps insertion path 19 functions as a treatment device insertion path for inserting a treatment device such as a forceps or a laser transmission path 70.

  In FIG. 1, the diameter is enlarged from the middle of the flexible tube portion 22 to the distal end of the bending tube portion 23, but this is for easy understanding of the configuration of the distal end configuration portion 30. Actually, it has a shape with a constant diameter suitable for insertion into the living body such as the esophagus, stomach, and intestines.

  The flexible tube portion 22 has a cylindrical shape that is appropriately curved, and can insert a therapeutic device such as an appropriate forceps inserted from the forceps insertion port 20 up to the distal end configuration portion 30. In this embodiment, a laser transmission path 70 of a laser treatment apparatus 50 is inserted as a treatment device.

The bending tube portion 23 is bent in the vertical direction by the operation of the vertical angle knob 16 and is bent in the horizontal direction by the left and right angle knob 17.
Specifically, the bending tube portion 23 is connected to the vertical angle knob 16 and the horizontal angle knob 17 by wires (not shown) inserted into the endoscope tube 21. For this reason, the rotation operation of the up-down angle knob 16 and the left-right angle knob 17 is transmitted to the bending tube portion 23 by the wire, and the bending tube portion 23 bends up, down, left and right. Thereby, the bending tube part 23 can be bent at an arbitrary angle in an arbitrary direction, and the distal end component part 30 can be directed in an appropriate direction toward the treatment target site.

The distal end configuration unit 30 is provided with light guides 31 and 35, a lens 33, a nozzle 34, and a forceps outlet 36.
The light guides 31 and 35 are illumination parts that irradiate light serving as illumination for imaging. This makes it possible to observe and perform treatment by illuminating the inside of the body where light does not reach.

  The lens 33 is a lens for collecting a reflected image of a living body by illumination of the light guides 31 and 35 and acquiring a captured image. A captured image can be obtained by appropriately processing the collected information, and the operator can check the state. An image sensor that converts light into an electrical signal may be provided in the vicinity of the distal end component 30 and connected to the endoscope apparatus 10 with a conductive wire, or may be provided in the endoscope apparatus 10 and provided by an image guide. Light collected by the lens may be transmitted.

The nozzle 34 is a part that discharges a cleaning liquid or the like for cleaning the lens 33 toward the lens 33.
The forceps outlet 36 is an outlet of a treatment device such as the laser transmission path 70 of the laser treatment apparatus 50.
The laser transmission path 70 is formed longer than the forceps insertion path length L1 which is also the entire length of the endoscope tube 21. Details of the laser transmission path 70 will be described later.

  As shown in FIG. 2, the laser treatment apparatus 50 includes an operation unit / display unit 51, a power supply unit 52, a signal processing unit 53, a central control unit 54 corresponding to the laser control unit, a detection unit 55, a guide light emitting unit 56, A laser oscillation unit 57, an assist gas injection unit 59, a cooling water supply unit 60, a cooling water recovery unit 61, and an affected part treatment water injection unit 62 corresponding to the laser generation source are provided.

The operation unit / display unit 51 receives an operation input such as a laser output setting or an operation mode change and transmits an input signal to the central control unit 54, and the laser output condition, the operation status of the apparatus, etc. from the central control unit 54 The display signal is received and appropriate information is displayed.
The power supply unit 52 supplies operating power to each unit such as the central control unit 54.

  The signal processing unit 53 processes the signal detected by the detection unit 55 and transmits it to the central control unit 54. In this embodiment, the signal processor 53 and the detector 55 constitute an OCT (Optical Coherence Tomography) apparatus.

  The detection unit 55 transmits, from the guide light emitting unit 56, the reflected guide light 55a (signal light) obtained by reflecting the low coherence guide light 56a irradiated from the guide light emitting unit 56 at the treatment target site. The received reference light is received to obtain interference light. The light received at this time is near infrared light in the vicinity of 800 nm to 1 μm.

  The detection unit 55 detects the light intensity of the beat signal generated by the interference between the reflection guide light 55a (signal light) and the reference light. The signal processing unit 53 performs heterodyne detection for obtaining the intensity of the signal light reflected from the predetermined surface of the treatment target site from the light intensity received from the detection unit 55, and acquires optical coherence tomographic information.

  By performing this while changing the treatment target site to be detected, optical coherence tomographic information of each treatment target site can be obtained. Thereby, optical coherence tomographic information including a tissue profile of a certain depth from the surface is obtained, and not only the surface mucosal layer but also the tissue profile to the submucosa and muscle layers are obtained. This optical coherence tomographic information is information before performing the imaging process. Then, the signal processing unit 53 transmits this optical coherence tomographic information to the central control unit 54.

The central control unit 54 performs various control operations on each unit. The central control unit 54 includes a laser output control unit 54a and a storage unit 54b.
The laser output control unit 54 a controls the output value of the therapeutic laser beam 57 a from the laser oscillation unit 57 in accordance with the output set by the operation unit / display unit 51 and the operation mode.
The storage unit 54b stores appropriate data in addition to control data such as output settings and operation mode settings.

As described above, the detection unit 55 receives the reflection guide light 55a (signal light) and the reference light, and detects the light intensity of the beat signal generated from the interference light.
The guide light emitting unit 56 emits near-infrared light with a low coherence having a wavelength in the vicinity of 800 nm to 1 μm. This guide light is for indicating the position where the therapeutic laser beam 57a for treatment is irradiated. Near-infrared light is invisible, but can be detected and imaged by an image sensor, so that it is converted into an image signal by an imaging unit 46 of the endoscope apparatus 10 to be described later, and is displayed on an image display unit 48. The position where the therapeutic treatment laser beam 57a is irradiated can be confirmed.

The laser oscillation unit 57 oscillates a treatment laser beam 57a used for treatment. In this embodiment, a carbon dioxide gas laser (hereinafter referred to as a CO ₂ laser) having a wavelength of 10.6 μm is used as the therapeutic laser beam 57a. Operations such as setting the irradiation intensity of the CO ₂ laser and starting and stopping 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 to be able to communicate and control the laser treatment apparatus 50.

  The guide light 56a irradiated by the guide light emitting unit 56 described above, the therapeutic laser light 57a oscillated by the laser oscillation unit 57, and the reflected guide light 55a detected by the detection unit 55 are all transmitted by one hollow waveguide 90. The Therefore, these are all transmitted coaxially, and the site | part which acts on a treatment object, and the site | part to detect correspond as a treatment object site | part.

  The assist gas injection unit 59 injects carbon dioxide as the assist gas 59a. Note that it is desirable that the injection pressure of the assist gas 59a that passes through a laser transmission path 70 described later and is ejected from the tip of the laser transmission path 70 to the treatment target site is grasped by an appropriate pressure acquisition unit.

The cooling water supply unit 60 supplies cooling water 60a for cooling the hollow waveguide 90 heated by the therapeutic laser beam 57a, and the cooling water recovery unit 61 recovers the cooling water 60a that has cooled the hollow waveguide 90. The cooling water 60a can be circulated by being recovered by the cooling water recovery unit 61 and then supplied by the cooling water supply unit 60. In addition, the cooling water 60a may be not only physiological saline but also fresh water.
The affected area treated water injection section 62 can inject physiological saline as the affected area treated water 62a in order to keep the affected area raised during the operation.

The endoscope apparatus 10 includes an operation unit 41, a power supply unit 42, a central control unit 43, an affected part gas suction unit 44 corresponding to a fluid suction unit, an illumination unit 45, an imaging unit 46, and an image display unit 48.
The operation unit 41 transmits an operation input by 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 vertical angle knob 16 and the left and right angle knob 17, the pressing operation by the operation button 18, and the like are transmitted. Alternatively, separately from the operation unit 12, for example, an operation unit is provided in a controller main body (not shown) of the endoscope apparatus, and operations such as illumination light quantity and still image shooting and storage are performed in the central control unit 43. introduce.

The power supply unit 42 supplies operating power to each unit such as the central control unit 43.
The central control unit 43 executes various control operations on each unit.
The affected part gas suction part 44 is formed between a laser transmission path 70 to be described later and the forceps insertion path 19 of the endoscope tube 21, and fills the affected part through the suction conduction path 19b corresponding to the fluid suction line. The affected part gas 44a is inhaled.
The illumination unit 45 performs illumination from the light guides 31 and 35 (see FIG. 1).

  The imaging unit 46 captures an image transmitted from the lens 33 (see FIG. 1) and obtains a captured image necessary for the treatment. By continuously acquiring the captured images in real time, the surgeon can perform the treatment smoothly.

  The image display unit 48 displays an image based on a signal transmitted from the central control unit 43. This image includes a captured image acquired by the imaging unit 46. Therefore, the surgeon can perform the procedure while confirming the captured image displayed on the image display unit 48 in real time. Further, the pre-operative image is stored as a still image in, for example, the central control unit 43 or a communicable external storage device, and the pre-operative image is called and displayed after the operation. Can also be compared.

  Next, the laser transmission path 70 will be described with reference to FIGS. FIG. 3 is an explanatory diagram based on a perspective view for explaining the configuration of the operator operation unit 12. Specifically, FIG. 3 (a) shows a perspective view of the bending tube portion 23, and FIG. 3 (b) shows an enlarged view of a portion in FIG. 3 (a).

  FIG. 4 is a perspective view for explaining the configuration of the laser transmission path 70, and FIG. 4A is a perspective view of the laser transmission path 70 with the outer tube 80 and the tip injection port 71 cut out. 4 (b) is a perspective view of the outer tube 80, FIG. 4 (c) is a perspective view of the tip injection port 71, FIG. 4 (d) is a perspective view of the hollow waveguide 90, and FIG. 4 (e). FIG. 3 shows a perspective view of the tip injection port 71 in a state where the hollow waveguide 90 is inserted.

  4B shows the distal end insertion portion 80a into which the distal end injection port 71 is inserted at the distal end of the outer tube 80 in a transparent state. FIG. 4E shows a hollow waveguide 90 in a transmissive state while being partially cut away.

  Further, FIG. 5 is an explanatory view of the laser transmission path 70 by a cross-sectional view, and FIG. 5A is a cross-sectional view taken along the line C-C of the laser transmission path 70 attached to the forceps insertion path 19 of the endoscope tube 21. FIG. 5B shows a cross-sectional view taken along the line AA in FIG. 5A, and FIG. 5C shows FIG. 5A. ) In FIG.

  The laser transmission path 70 includes an outer tube 80, a tip injection port 71 called a stainless steel, and a hollow waveguide 90, and is longer than the endoscope tube 21 as described above.

  The outer tube 80 is a hollow flexible resin tube having an insertion space 81 corresponding to the insertion hole therein, and has a diameter substantially the same as the inner diameter of the forceps insertion path 19 of the endoscope tube 21. Then, between the outer peripheral convex portion 82 corresponding to the protruding portion and the adjacent outer peripheral convex portions 82, the outer peripheral convex portion 82 is concave and is inserted into the endoscope tube 21. The suction conduction path 19b is formed by a gap formed between the inner peripheral surface 19a, and a concave portion or an outer peripheral concave portion 83 corresponding to the gap forming portion is arranged in parallel in the circumferential direction so as to have a substantially gear-shaped cross section when viewed from the front. Forming.

  The inhalation conduction path 19b is connected to the affected part gas inhalation part 44 of the endoscope apparatus 10 as described above, and the above-mentioned affected part gas 44a is connected to the affected part gas inhalation part 44 through the inhalation conduction path 19b. Will be inhaled.

In addition, a distal end insertion portion 80 a that allows insertion of a distal end injection port 71 described later is formed at the distal end of the insertion space 81 of the outer tube 80.
Further, in the range other than the distal end insertion portion 80 a in the insertion space 81 of the outer tube 80, the sub pipes 84 (84 a, 84 b, 84 c) corresponding to the fluid pipes are provided in the inner three directions in the inner three directions. The surface is provided along the longitudinal direction of the outer tube.
In addition, each sub-pipe 84 is formed in such a size that the radially inner tip portion of the three-way sub-pipe 84 is arranged in a circle that is slightly larger than the outer diameter of the hollow waveguide 90 that is inserted into the insertion space 81. Yes.

  The distal end injection port 71 is a substantially cylindrical body that is press-fitted into the distal end insertion portion 80a at the distal end of the outer tube 80. The front side (affected side) in the axial direction, that is, the longitudinal direction is the front side cylindrical portion 71a, and the rear side is the rear side cylindrical portion. 71b.

  The tip injection port 71 has a central irradiation hole 72 penetrating in the axial direction, that is, the longitudinal direction of the tip injection port 71 in the center in a front view, and in three directions on the outer side of the diameter, a portion corresponding to the sub pipe line 84. Further, an assist gas injection hole 73, a water injection hole 74, and a cooling water circulation path 75 are provided.

  In addition, the central irradiation hole 72 is formed in the front side cylinder part 71a by the diameter substantially the same as the outer diameter of the hollow waveguide 90, the front irradiation hole 72a which accept | permits insertion of the hollow waveguide 90, and the rear side cylinder part 71b. The back irradiation hole 72b is formed with a diameter slightly larger than the outer diameter of the hollow waveguide 90 and forms a gap around the inserted hollow waveguide 90 (see FIG. 4E).

Further, the assist gas injection hole 73 and the water injection hole 74 penetrate in the axial direction, that is, the longitudinal direction of the tip injection port 71.
On the other hand, the cooling water circulation path 75 is bent from the rear of the tip injection port 71 to the front, connected to the front of the rear irradiation hole 72b, and penetrates from the rear of the tip injection port 71 to the front of the rear irradiation hole 72b. It is a hole. Accordingly, the assist gas injection hole 73 communicates with the assist gas sub-pipe 84a, the water injection hole 74 communicates with the affected part treated water sub-pipe 84b, and the cooling water circulation path 75 communicates with the cooling water recovery sub-pipe 84c. To do.

  As shown in the longitudinal sectional view of FIG. 5A, the hollow waveguide 90 has a tip that can be inserted into the front irradiation hole 72a of the central irradiation hole 72 and has an outer periphery having the same diameter as the inner periphery of the front irradiation hole 72a. It is a cylindrical body, and is configured by covering the entire inner surface of a hollow cylindrical cylindrical body with a dielectric thin film 91. The cylindrical body constituting the hollow waveguide 90 has a smooth surface such as a glass tube, is formed in a long shape by a material suitable for forming a reflective film such as silver and a dielectric thin film, and the dielectric thin film 91 is a COP. (Cyclic olefin polymer), polyimide, or the like is formed of an appropriate material that efficiently reflects and transmits laser light.

  Thus, since the inner peripheral surface of the hollow waveguide 90 is covered with the reflective film such as silver and the dielectric thin film 91, the therapeutic laser beam 57a that conducts the conduction space 92 inside the hollow waveguide 90, the guide The light 56a or the reflected guide light 55a can be conducted with high transmission efficiency.

  Since the hollow waveguide 90 is formed of a cylindrical body having an outer periphery having the same diameter as the inner periphery of the front irradiation hole 72a of the central irradiation hole 72 as described above, the inner peripheral surface 80b of the outer tube 80 is formed. And a cooling water conduit 85 corresponding to the fluid conduit is formed between the outer peripheral surface 90 a of the hollow waveguide 90.

  Specifically, the cooling water conduit 85 formed between the outer peripheral surface 90 a of the hollow waveguide 90 and the inner peripheral surface 80 b of the outer tube 80 is composed of the rear irradiation hole 72 b of the central irradiation hole 72 and the outer periphery of the hollow waveguide 90. It communicates with a gap formed between the surfaces 90a. Then, the cooling water pipe 85 is connected to the cooling water collecting sub pipe 84c via the gap formed between the rear irradiation hole 72b of the central irradiation hole 72 and the outer peripheral surface 90a of the hollow waveguide 90 and the cooling water circulation path 75. Communicating with

  As described above, the base portion of the assist gas sub-pipe 84 a is connected to the assist gas injection portion 59 of the laser treatment apparatus 50. Therefore, the assist gas 59a injected by the assist gas injection unit 59 is conducted from the base end side to the tip end through the assist gas sub-pipe 84a, and is injected forward from the assist gas injection hole 73 of the tip injection port 71. can do.

  The base part of the affected part treated water sub-pipe 84 b is connected to the affected part treated water injection part 62 of the laser treatment apparatus 50. Therefore, in the affected part treated water sub-pipe 84b, the affected part treated water 62a injected by the affected part treated water irrigating part 62 is conducted from the proximal end toward the distal end, and forward from the irrigation hole 74 of the distal end injection port 71. Can be released.

  The base of the cooling water pipe 85 is connected to the cooling water supply part 60 of the laser treatment apparatus 50, and the base of the cooling water collection sub pipe 84 c is connected to the cooling water collection part 61 of the laser treatment apparatus 50. Therefore, the cooling water 60a supplied from the cooling water supply unit 60 is conducted to the cooling water pipe 85 from the base end side toward the tip, passes through the cooling water circulation path 75, and passes the cooling water collection sub pipe 84c to the rear. The cooling water collecting unit 61 can conduct the recovery.

Next, a method of use in endoscopic submucosal dissection (ESD) using the laser treatment system 1 will be described.
As described above, in endoscopic submucosal dissection (ESD) using the laser treatment system 1, the operator operation unit 12 having the laser transmission path 70 inserted through the forceps insertion path 19 is inserted into the body, Based on the forward image of the distal end component 30 imaged by the imaging unit 46 displayed on the image display unit 48, the distal end component 30 of the operator operation unit 12 is inserted until it reaches the surgical site. The site to be treated is a lumen such as the esophagus or stomach, and is an appropriate part of a living body including a human.

Then, the assist gas injection unit 59 is operated, and the assist gas 59a is ejected through the assist gas sub-pipe 84a and the assist gas injection hole 73 of the tip injection port 71 to enlarge the lumen as the treatment target site. , Make it easy to spread and treat.
Further, the affected area treated water injection section 62 is operated, and the affected area treated water 62a is discharged through the affected area treated water sub-pipe 84b and the water injection hole 74 of the tip injection port 71 to raise the treatment target site. Make it easy to do.

  Furthermore, while confirming the image of the image display unit 48, the guide light 56a that conducts through the conducting space 92 of the hollow waveguide 90 and the treatment laser light 57a are irradiated from the central irradiation hole 72 of the tip injection port 71 to treat the treatment. The site to be treated is treated with the laser beam 57a.

  At this time, since the treatment target site is incised and peeled off by the treatment laser beam 57a, although the inside of the lumen as the treatment target site is filled with smoke, the assist gas 59a is injected and the affected part gas suction unit 44 is operated. By doing so, the affected part gas 44a containing smoke in the lumen can be absorbed by the affected part gas inhalation part 44 through the inhalation conduction path 19b. Therefore, it is possible to keep the inside of the lumen that is the treatment target portion clear.

  Then, the cooling water supply unit 60 and the cooling water recovery unit 61 are operated, and the cooling water 60a is circulated through the cooling water pipe 85, the cooling water circulation path 75, and the cooling water collection sub pipe 84c, so that the therapeutic laser beam is used. The hollow waveguide 90 heated by 57a can be cooled with the cooling water 60a. In addition, since the cooling water pipe 85 is configured to contact the outer peripheral surface of the heated hollow waveguide 90, the hollow waveguide 90 can be efficiently cooled with the cooling water 60a.

Further, the treatment laser beam 57a uses a CO ₂ laser having high water absorption, and the cooling water 60a is supplied to the cooling water pipe 85 around the hollow waveguide 90. Even if the treatment laser light 57a that is broken and guided through the conduction space 92 leaks out (erroneous irradiation), the external view of the outer tube 80 and the operator operation unit 12 due to the erroneous irradiation of the therapeutic laser light 57a. The occurrence of damage to the mirror tube 21 can be prevented. Therefore, the operator operation unit 12 with high safety and reliability can be configured.

  Furthermore, the cooling water 60a is supplied from the cooling water supply unit 60 and is recovered by the cooling water recovery unit 61 through the cooling water pipe 85, the cooling water circulation path 75, and the cooling water recovery sub pipe 84c. Since the cooling water 60a circulates without leaking to the outside, for example, fresh water may be used instead of physiological saline.

  Then, after the treatment is completed, the operator operation unit 12 is inserted from the body, and the endoscopic submucosal dissection (ESD) is completed. In addition, even if it is endoscopic mucosal resection (EMR), it can be performed by the same usage method.

  In this way, together with the hollow waveguide 90 formed into an elongated hollow shape for guiding the therapeutic laser beam 57a, the laser transmission path 70 inserted into the forceps insertion path 19 in the endoscope tube 21 is configured. An outer tube 80 that allows the hollow waveguide 90 to be inserted into the internal insertion space 81, and on the inner surface of the forceps insertion path 19 in at least two directions in the cross section when inserted into the forceps insertion path 19. An outer peripheral convex portion 82 projecting outward in the radial direction with which the projecting tip abuts, and an outer peripheral concave portion 83 forming a gap between the adjacent outer peripheral convex portions 82 and the inner surface of the forceps insertion path 19, The laser transmission path 70 is configured by the tube 80, and the laser transmission path 70 configured by the exterior tube 80 is replaced with the forceps insertion path in the endoscope tube 21 that configures the operator operation unit 12. 9, the smoke is inhaled through the inhalation conduction path 19 b formed by the outer peripheral recess 83, and in the cauterization operation with the therapeutic laser beam 57 a, particularly in ESD and EMR, the treatment target space is widened and the field of view is increased. Can be secured. Therefore, reliable and safe treatment can be performed.

  Further, by inserting the laser transmission path 70 constituted by the outer tube 80 into the forceps insertion path 19 in the endoscope tube 21 constituting the operator operation unit 12, the laser transmission path 70 may be positioned at the center of the forceps insertion path 19. it can.

  Further, the plurality of outer peripheral convex portions 82 and the outer peripheral concave portions 83 are continuously arranged in the circumferential direction and formed in a cross-sectional gear shape, so that the laser transmission path 70 constituted by the outer tube 80 can be more reliably inserted into the forceps insertion path. The smoke can be sucked by the suction conducting path 19b formed by the concave outer circumferential recess 83 formed in the circumferential direction.

  Further, by providing the sub-pipe 84 and the cooling water pipe 85 between the hollow waveguide 90 inserted into the insertion space 81 and the inner peripheral surface 80b of the outer tube 80, the cooling water 60a, the affected part treated water 62a, A fluid such as the assist gas 59a can be conducted. For example, a desired fluid is conducted to the sub-pipe 84 and the cooling water pipeline 85 such that the cooling water 60a is conducted to the cooling water pipeline 85 and the hollow waveguide 90 heated by the therapeutic laser beam 57a is cooled. Therefore, it is possible to perform treatment more reliably and safely.

  In addition, the laser transmission path 70 inserted through the hollow waveguide 90 into the insertion space 81 of the outer tube 80 allows the smoke to be inhaled by the inhalation conduction path 19b formed by the outer peripheral recess 83, and the treatment laser beam 57a is used to ensure the treatment target site. Can be treated.

  Furthermore, the laser oscillation unit 57, the central control unit 54, and the laser transmission path 70 are provided, and the endoscope is arranged so that the distal end portion of the laser transmission path 70 is located in the vicinity of the distal end opening of the endoscope tube 21. Laser that is inserted into the forceps insertion path 19 in the mirror tube 21, connects the affected part gas suction part 44 to the outer peripheral recessed part 83, and forms the inhalation conducting path 19 b in the outer peripheral recessed part 83, thereby irradiating the therapeutic laser light 57 a. The distal end portion of the transmission path 70 can be reliably conducted to the treatment target site.

Further, by configuring the treatment laser beam 57a with a carbon dioxide laser (CO ₂ gas), smoke can be inhaled by the outer peripheral recess 83, and the treatment target site can be treated safely. Specifically, since a carbon dioxide gas laser (CO ₂ gas) having high water absorbability and high biological surface absorbability is used for the treatment laser light 57a in a bright field, the minimum necessary laser can be irradiated, Can be treated safely.

In addition, since CO ₂ gas having bioabsorbability is used as the assist gas 59a, the assist gas 59a that fills the post-surgical site to be treated is rapidly absorbed, and postoperative fullness and pain are suppressed. be able to. Also, even if the assist gas 59a is mixed into the blood vessel, there is no possibility of causing blood embolism due to the bioabsorbability of the assist gas 59a.

  In this manner, the treatment laser beam 57a is conducted to the hollow waveguide 90, and the assist gas 59a is conducted through the assist gas sub-pipe 84a and the assist gas injection hole 73 of the tip injection port 71, thereby assist gas. The target laser beam 57a is used to ensure the target area of treatment by injecting it into the target site such as the esophageal wall and stomach wall in 59a to secure the visual field by expanding the treatment space and securing the visual field by removing smoke. Can be treated.

Furthermore, in the operator operation unit 12 having a plurality of forceps insertion paths 19, the laser transmission path 70 is inserted into one forceps insertion path 19, and the distal end portion of the laser transmission path 70 is connected to the endoscope tube 21. The forceps insertion path 1 is disposed at the distal end configuration part 30.
9 is equipped with an optical system including an illuminating unit 45, so that the distal end constituting unit 30 of the endoscope tube 21 of the operator operation unit 12 is subjected to an operation while confirming an image captured by the illuminating unit 45. It is possible to reliably reach the nearest part.

  Therefore, the assist gas 59a is injected into the body to be treated such as the esophageal wall and stomach wall to secure the visual field by expanding the treatment space, secure the visual field by removing smoke, and confirm the captured image. However, the treatment target site can be more reliably treated with the therapeutic laser beam 57a.

  In the above description, the laser transmission path 70 using the outer tube 80 that is formed in a cross-sectional gear shape having the outer peripheral convex portion 82 and the outer peripheral concave portion 83 on the outer periphery and that has the sub-pipe lines 84 in three directions in the insertion space 81. Is inserted into the forceps insertion path 19 of the endoscope tube 21 to form a suction conduction path 19b between the inner surface of the forceps insertion path 19 and the outer peripheral convex portion 82, and the outer surface of the hollow waveguide 90 and the outer tube 80. Although the cooling water pipe 85 is formed between the inner peripheral surface 80b of the laser beam and the laser transmission path 70, an outer tube 80 having another shape may be used as shown in FIG.

  For example, the exterior tube 180 shown in FIG. 6A has a substantially triangular shape in a front view formed by three convex apex portions 182 and a side portion 183 that is concave in the radial direction compared to the apex portion 182 therebetween. And has an insertion space 81 in the center of the front view, and has sub ducts 184 (184a, 184b, 184c) in the vicinity of each vertex 182.

The insertion space 81 is formed with a diameter larger than that of the hollow waveguide 90 to be inserted, and a cooling water pipe 185 is formed around the inserted hollow waveguide 90.
The apex portion 182 contacts the inner peripheral surface 19 a of the forceps insertion path 19 of the endoscope tube 21, and an inhalation conduction path 19 b is formed between the inner peripheral surface 19 a of the forceps insertion path 19 and the side portion 183. doing.

  The outer tube 280 shown in FIG. 6 (b) is formed in a substantially gear shape in front view that includes an outer peripheral convex portion 82 and an outer peripheral concave portion 83, and has an insertion space 81 at the center in front view, The circumferential pipe is divided into three at equal intervals in the circumferential direction to form sub pipes 284 (284a, 284b, 284c).

  The outer tube 380 shown in FIG. 6C is in contact with the inner peripheral surface 19a of the forceps insertion path 19 at the arc portion 382 on the long axis side, and the arc portion 383 on the short axis side and the inner peripheral surface 19a of the forceps insertion path 19 are. Is formed in a vertically long oval shape that forms a suction passage 19b.

In this case, the insertion space 81 is provided at the center in the front view, the sub-channel 384 (384a, 384c) is provided inside the arc portion 383 on the short axis side, and the cooling water conduit 385c is provided around the inserted hollow waveguide 90. Is forming.
By configuring in this way, even the exterior tubes 180, 280, and 380 illustrated in FIGS. 6A to 6C can achieve the same effects as the above-described exterior tube 80.

In the above description, a carbon dioxide laser (CO ₂ gas) is used as the treatment laser beam 57a, but other appropriate treatment laser beam may be used.
Furthermore, in the curved tube portion 23, the hollow waveguide 90 may be inserted into the protective metal tube, and the outside of the hollow waveguide 90 may be surrounded by the protective metal tube. As a result, the bending tube section 23 can be freely bent, and the practitioner can perform laser treatment safely and reliably in a good working environment.

  The laser treatment apparatus 50 is provided with a SAG injection unit that injects an appropriate gas that does not absorb laser light such as air and bioabsorbability as a sub-assist gas (hereinafter referred to as SAG), and includes treatment laser light 57a and SAG. The treatment target site may be treated with the treatment laser beam 57a by irradiating and ejecting from the central irradiation hole 72 of the tip ejection port 71. In this case, since SAG is injected into the conduction space 92 of the hollow waveguide 90 together with the therapeutic laser beam 57a, the central irradiation hole 72 of the transpiration generated by the incision / separation of the treatment target site by the therapeutic laser beam 57a Intrusion into the conductive space 92 can be prevented.

The SAG uses air having a lower bioabsorbability than the CO ₂ gas used as the assist gas 59a. In addition, the SAG secures a suction path at the outer peripheral recess, and the SAG is connected to the hollow waveguide 90. Since the injection amount and the injection pressure are such that the space 92 is set to a positive pressure and the transpiration is prevented from entering the central irradiation hole 72 of the laser transmission path 70, it affects the generation of fullness and pain after the operation. do not do. Furthermore, since the SAG has the above-described injection amount and injection pressure, it is safe without causing a blood vessel embolism (air embolism) due to air entering the blood vessel and air bubbles remaining therein.

In correspondence between the configuration of the present invention and the above-described embodiment,
The laser beam of the present invention corresponds to the therapeutic laser beam 57a,
Similarly,
The endoscope external hose corresponds to the endoscope tube 21,
The transmission path insertion hole corresponds to the forceps insertion path 19,
The insertion hole corresponds to the insertion space 81,
The fluid pipes are sub pipes 84, 184, 284, 384, assist gas sub pipes 84a, 184a, 284a, 384a, affected area treated water sub pipes 84b, 184b, 284b, cooling water recovery sub pipes 84c, 184c, 284c, 384c, and cooling water pipes 85, 185, 285, 385,
The inner surface of the transmission path insertion hole corresponds to the inner peripheral surface 19a,
The protruding portion corresponds to the outer peripheral convex portion 82, the vertex portion 182 and the arc portion 382 on the long axis side,
The concave part or the gap forming part corresponds to the outer peripheral concave part 83, the side part 183, and the arc part 383 on the short axis side,
The laser source corresponds to the laser oscillation unit 57,
The laser control unit corresponds to the central control unit 54,
The fluid suction means corresponds to the affected part gas suction part 44,
The fluid suction line corresponds to the suction conduction path 19b,
The laser control unit corresponds to the central control unit 54,
The laser treatment instrument corresponds to the operator operation unit 12,
The present invention is not limited only to the configuration of the above-described embodiment, and many embodiments can be obtained.

  For example, the configuration may be such that both the injection amount and the ejection pressure of the assist gas 59a are detected, and the operation of the laser treatment system 1 is stopped based on an abnormal detection result. More specifically, the assist gas 59a injection amount and the ejection pressure are independently detected or relatively detected to block the assist gas sub-pipe 84a and the assist gas injection hole 73 through which the assist gas 59a passes. Damage or the like can be detected. In this case, since there is a possibility that accurate treatment cannot be performed, stop control for immediately stopping the operation of the laser treatment system 1 is performed. Thereby, the laser treatment system 1 with high safety and reliability can be configured.

  The present invention can be used in various devices that treat a living body using laser light. In particular, the present invention can be applied to an apparatus that transmits a laser beam using a laser beam transmission path to perform treatment and treatment while securing a suction path in a limited space such as an endoscope.

12 ... operator operation unit 19 ... forceps insertion path 19a ... inner peripheral surface 19b ... inhalation conduction path 21 ... endoscope tube 44 ... affected part gas inhalation part 54 ... central control part 57 ... laser oscillation part 57a ... treatment laser beam 59a ... assist gas 60a ... cooling water 62a ... affected part treated water 70 ... laser transmission path 75 ... cooling water circulation path 80, 180, 280, 380 ... outer tube 81 ... insertion space 82 ... outer peripheral convex part 83 ... outer peripheral concave part 84, 184 284, 384 ... sub pipes 84a, 184a, 284a, 384a ... assist gas sub pipes 84b, 184b, 284b ... affected area treated water sub pipes 84c, 184c, 284c, 384c ... cooling water recovery sub pipe 85 , 185, 285, 385 ... cooling water pipe 90 ... hollow waveguide 182 ... apex 382 ... arc portion 183 on the long axis side ... side 383 ... on the short axis side Arc part

Claims (8)

Along with a hollow waveguide formed in a long and hollow shape for guiding laser light, a laser transmission path inserted into the transmission path insertion hole in the endoscope external hose is formed, and the hollow guide is formed in the internal insertion hole. An outer tube that allows insertion of a waveguide,
On the outside,
In the insertion state to the transmission path insertion hole, in at least two directions in the cross section, a projecting portion projecting outward in the radial direction in which the projecting tip contacts the inner surface of the transmission path insertion hole;
A gap forming portion that forms a gap between the adjacent projecting portions and the inner surface of the transmission path insertion hole, and
An exterior tube provided with a fluid conduit inside the outer surface and the inner surface of the insertion hole . A plurality of irregularities are formed in a cross-sectional gear shape continuously arranged in the circumferential direction,
The exterior tube according to claim 1, wherein the protrusion and the gap forming portion are configured by the unevenness. Formed into a polygonal cross-section,
The exterior tube according to claim 1, wherein the projecting portion is configured by the polygonal apex portion, and the gap forming portion is configured by the polygonal side portion. Formed in an elliptical cross section,
The outer tube according to claim 1, wherein the projecting portion is configured by the elliptical arc portion on the long axis side, and the gap forming portion is configured by the elliptical arc portion on the short axis side. The exterior tube in any one of Claims 1 thru | or 4 provided with the fluid pipe line between the said hollow waveguide inserted in the said insertion hole, and the inner surface of the said insertion hole. A laser transmission path in which the hollow waveguide is inserted into the insertion hole in the exterior tube according to claim 1. A laser source;
A laser controller;
A laser transmission path according to claim 6,
The laser transmission path is inserted through a transmission path insertion hole in the endoscope external hose so that the distal end of the laser transmission path is positioned near the distal end opening of the endoscope external hose,
A laser treatment instrument in which a fluid suction means is connected to the gap forming portion to form a fluid suction conduit at the gap forming portion. The laser treatment instrument according to claim 7, wherein the laser beam is a carbon dioxide laser.

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