JP4772386B2 - Submucosal layer peeling treatment tool set and submucosal layer peeling treatment tool system - Google Patents

Description

  The present invention relates to a submucosal stripping treatment tool set and a submucosal stripping treatment device system for excising a lesion in the digestive tract.

As a general treatment method for gastrointestinal lesions, endoscopic mucosal resection (EMR) in which a lesion is removed using an endoscope is conventionally known.
Among them, as an “incision / peeling method”, a method is described in which a normal mucous membrane outside the lesion is completely incised using a high-frequency incision tool such as a high-frequency knife, and then the submucosa is exfoliated and excised (see FIG. For example, refer nonpatent literature 1.).
In addition, what is used for another treatment as another form of such a high frequency knife is proposed (for example, refer patent document 1).
Hiroyuki Ono and three others, "EMR Tips Using IT Knives for Early Cancer", Gastrointestinal Endoscopy, Gastrointestinal Endoscopy Editorial Committee, Tokyo Medical Co., Ltd., November 2002, Volume 14 No. 11, p. 1737-1740 US 2001/0049497 A1

However, the following problems remain in the conventional treatment tool.
That is, when performing incision / exfoliation by the “incision / exfoliation method” using a conventional treatment instrument, a large number of blood vessels run in the submucosal layer. Special considerations such as changing the output setting of the apparatus as needed are necessary, and there is a problem that the procedure time becomes long.
In addition, incision and detachment with a high-frequency knife, in order to achieve an appropriate sharpness while preventing thermal damage due to high-frequency energy to the incision target part, appropriate strength, angle, knife moving speed, etc. are applied. There was a problem that the technique was difficult to control.

  In addition, when incising a lesion bulged with a high-frequency knife, the high-frequency knife is always in contact with the surface of the digestive tract (the surface of the non-bulged portion around the lesion) at a certain angle. It was an end. That is, in a limited space in the digestive tract, it was impossible to incise around the swollen lesion by moving the high-frequency knife parallel to the surface of the digestive tract. Therefore, when the high-frequency knife is cut, the tip of the high-frequency knife is placed at a predetermined position so that the tip of the high-frequency knife is not inserted into the intrinsic muscle layer (a layer that does not bulge even when applied locally). It was necessary to be positioned at a predetermined depth), and advanced technique and concentration were required, and the burden on the surgeon was large.

  The present invention has been made in view of the above-mentioned problems of the prior art, and the purpose thereof is to easily perform a procedure in a short time when excising a lesion of the digestive tract, and to improve the skill of the operator. It is intended to provide a submucosal layer peeling treatment tool set and a submucosal layer peeling treatment tool system that can perform a safe procedure without being influenced by the above.

In order to achieve the above object, the present invention provides the following means.
The submucosal layer exfoliation treatment instrument set of the present invention is a submucosal layer exfoliation instrument set for locally exfoliating the submucosal layer and excising the lesioned part of the digestive tract. A conduit formed from the proximal end side to the distal end side of the main body, a wire inserted into the conduit in a state where the distal end side is fixed, and the insertion portion fixed to the proximal end side of the wire an operation unit for bending the insertion portion main body in a predetermined direction by pushing and pulling operation of the wire with respect to the body, only one side of the predetermined direction with respect to the axis of the insertion portion main body in the distal end side of the insertion portion main body An auxiliary device provided with a flexible part that is more flexible than the other part , wherein the wire is disposed on the one side with respect to the shaft core and penetrates a predetermined size of the insertion route into the submucosa. The submucosa along the insertion route A flexible treatment instrument body inserted into the body, a fluid conduit formed from the proximal end side to the distal end side of the treatment instrument body, and a distal end side of the treatment instrument body. It is characterized by comprising a submucosal layer peeling treatment device including an inflating portion that expands when a supply of fluid is received via a conduit .

  In the submucosal layer exfoliation treatment instrument set according to the present invention, the distal end of the main body of the insertion portion of the auxiliary device is first brought close to a lesion that has been bulged by submucosal local injection or the like. Then, the insertion portion main body is bent in a predetermined direction by pushing and pulling the wire inserted into the pipe line by the operation portion. That is, when a wire having a distal end fixed to the insertion portion body is pushed and pulled, a compressive force or a tensile force is transmitted to the flexible insertion portion body, and the insertion portion body moves in a predetermined direction (for example, the vertical direction). Or bent in the left-right direction). Thereby, even if it is the space in a limited digestive tract, the curve degree of an insertion part main body can be adjusted so that it may become parallel to the surface of a digestive tract.

Then, the auxiliary device is moved in a direction parallel to the surface of the digestive tract and inserted into the submucosal layer of the bulging lesion. By this insertion, an insertion route penetrating in a direction parallel to the surface of the digestive tract with a predetermined size corresponding to the outer diameter of the insertion portion main body can be secured in the submucosal layer.
Next, the treatment tool body of the submucosal layer peeling treatment tool is inserted into the inserted insertion route. The treatment instrument body moves along the insertion route and is inserted into the submucosa. At this time, the treatment tool main body moves along the insertion route pierced by the auxiliary device, so that it is inserted into the submucosa in a state parallel to the surface of the digestive tract. After insertion, the fluid is supplied to the inflating part via the fluid conduit and inflated in the submucosa. Thereby, the submucosa can be easily peeled off.
In addition, by repeatedly performing insertion route penetration with the auxiliary device and peeling of the submucosal layer with the submucosal layer peeling treatment tool, a wide range of submucosal layers can be easily peeled one after another.

Thus, the submucosal layer can be peeled without using a conventional high-frequency knife, and the procedure can be facilitated to shorten the procedure time. At this time, even if there is bleeding in the lesion, the bleeding part can be compressed by inflating the expanding part, allowing rapid hemostasis of the bleeding part. Can be prevented in advance.
In particular, since the treatment instrument main body is inserted into the submucosa along the insertion route previously penetrated by the auxiliary device, the distal end side of the treatment instrument main body is inserted into the intrinsic muscle layer or the like below the submucosa as in the past. There is no possibility. Therefore, it is not necessary to pay extreme attention to the insertion depth of the distal end of the treatment instrument body. Therefore, a safe procedure can be performed without being influenced by the skill of the surgeon, and the burden on the surgeon can be reduced as much as possible.
In addition, since the flexible portion is provided on the distal end side of the insertion portion main body, the insertion portion main body can be more actively curved on the distal end side when the operation portion is pushed and pulled. Thereby, even if the protrusion amount from the endoscope tip is small, the bending can be performed reliably, and the procedure can be reliably performed even when the procedure space in the digestive tract is narrow.

In the submucosal layer exfoliation treatment instrument set, the flexible portion is more preferably a communication hole formed in the insertion portion main body and communicating the conduit and the outside.

Further, in the submucosal layer exfoliation treatment instrument set, the auxiliary device includes a bending auxiliary member having a cross-sectional characteristic that bends in a predetermined constant direction at least on a distal end side of the insertion portion main body, More preferably, the bending direction is the same direction .
In the submucosal layer exfoliation treatment instrument set according to the present invention, since the bending auxiliary member is provided at least on the distal end side of the insertion portion main body, for example, when the insertion portion main body is inserted into the channel of the endoscope, The bending assisting member is inserted into the channel so that the bending assisting member automatically follows the bending state (bending direction) of the endoscope. And finally, it protrudes to the outside in a state where the bending assisting member is aligned in the bending direction on the distal end side of the endoscope. That is, the bending direction on the endoscope distal end side coincides with a predetermined constant direction of the bending assisting member. That is, the auxiliary device automatically matches the bending direction of the endoscope with the bending direction of the endoscope when it protrudes from the distal end of the endoscope.
Thereby, the surgeon can quickly perform the bending operation of the insertion portion main body in the same direction as the bending direction of the endoscope without adjusting the bending direction. Therefore, the labor for adjusting the bending direction can be saved, and the procedure time for peeling off to the submucosal layer can be further shortened.

In the submucosal layer peeling treatment instrument set, it is more preferable that the bending assisting member is formed in a plate shape, and the thickness direction of the bending assisting member is the constant direction.

In the submucosal layer peeling treatment instrument set, it is more preferable that the auxiliary device has a spherical tip at the tip of the insertion portion main body .

  In the submucosal layer exfoliation treatment instrument set according to the present invention, since the distal end of the insertion portion main body is provided with a spherical distal end portion, when the insertion route is penetrated, the intrinsic muscle layer below the submucosal layer is temporarily inserted. Even if it touches etc., it is hard to damage a proper muscle layer etc. Therefore, the safety of the procedure can be further increased.

In the submucosal layer peeling treatment instrument set, it is more preferable that the auxiliary device includes an index portion that indicates the amount of insertion into the submucosal layer in the treatment instrument body .

  In the submucosal layer exfoliation treatment instrument set according to the present invention, it is possible to accurately grasp the insertion amount of the insertion portion main body into the submucosa layer by confirming the index portion, and the treatment instrument that is subsequently inserted into the insertion route The main body can be accurately positioned at a predetermined position in the submucosa. As a result, the desired part of the submucosa can be accurately peeled off.

Further, the submucosal layer exfoliation treatment tool set of the present invention is a submucosal layer exfoliation treatment tool set for locally exfoliating the submucosal layer and excising the lesioned part of the digestive tract, comprising a flexible insertion portion main body, A conduit formed from the proximal end side to the distal end side of the insertion portion main body, a wire inserted into the conduit with the distal end side fixed, and fixed to the proximal end side of the wire, an operation section with respect to the insertion portion main body to bend the insertion portion main body by pushing and pulling operation of the wire in a predetermined direction, one side of the predetermined direction with respect to the axis of the insertion portion main body in the distal end side of the insertion portion main body An auxiliary device that is provided only on the first portion and has a flexible portion that is more flexible than other portions , the wire is disposed on the one side with respect to the shaft core, and penetrates an insertion route of a predetermined size in the submucosal layer. When,
A flexible treatment instrument body inserted into the submucosa along the insertion route, a fluid conduit formed from the proximal end side to the distal end side of the treatment instrument body, and the treatment instrument An inflatable portion that is provided on the distal end side of the main body and expands when supplied with fluid via the fluid conduit; and from the proximal end side to the distal end side of the treatment instrument main body along the fluid conduit over formed, said inserting part and a submucosal treatment instrument and an insertion duct for inserting the main body, the length of the insertion portion main body, than the length of the insertion duct is long It is a feature.

In the submucosal layer peeling treatment tool set according to the present invention, the treatment tool main body of the submucosal layer peeling treatment tool is brought close to a lesion that has been previously bulged by submucosal local injection or the like. After making it approach, the insertion part main body of an auxiliary | assistant device is protruded from the penetration pipe line. At this time, since the length of the insertion portion main body is set to be longer than the insertion conduit, it can be reliably projected from the distal end of the treatment instrument main body.
After projecting the insertion portion main body, the distal end of the insertion portion main body is brought close to the lesioned portion. Then, the insertion portion main body is bent in a predetermined direction by pushing and pulling the wire inserted into the pipe line by the operation portion. That is, when a wire having a distal end fixed to the insertion portion body is pushed and pulled, a compressive force or a tensile force is transmitted to the flexible insertion portion body, and the insertion portion body moves in a predetermined direction (for example, the vertical direction). Or bent in the left-right direction). Thereby, even if it is the space in a limited digestive tract, the curve degree of an insertion part main body can be adjusted so that it may become parallel to the surface of a digestive tract.

Then, the auxiliary device is moved in a direction parallel to the surface of the digestive tract and inserted into the submucosal layer of the bulging lesion. By this insertion, an insertion route penetrating in a direction parallel to the surface of the digestive tract with a predetermined size corresponding to the outer diameter of the insertion portion main body can be secured in the submucosal layer.
Next, after the insertion portion main body is accommodated in the insertion duct of the treatment instrument main body, the treatment instrument main body is inserted into the inserted insertion route. The treatment instrument body moves along the insertion route and is inserted into the submucosa. At this time, the treatment tool main body moves along the insertion route pierced by the auxiliary device, so that it is inserted into the submucosa in a state parallel to the surface of the digestive tract. After insertion, the fluid is supplied to the inflating part via the fluid conduit and inflated in the submucosa. Thereby, the submucosa can be easily peeled off.
In addition, by repeatedly performing insertion route penetration with the auxiliary device and peeling of the submucosal layer with the submucosal layer peeling treatment tool, a wide range of submucosal layers can be easily peeled one after another.

Thus, the submucosal layer can be peeled without using a conventional high-frequency knife, and the procedure can be facilitated to shorten the procedure time. At this time, even if there is bleeding in the lesion, the bleeding part can be compressed by inflating the expanding part, allowing rapid hemostasis of the bleeding part. Can be prevented in advance.
In particular, since the treatment instrument main body is inserted into the submucosa along the insertion route previously penetrated by the auxiliary device, the distal end side of the treatment instrument main body is inserted into the intrinsic muscle layer or the like below the submucosa as in the past. There is no possibility. Therefore, it is not necessary to pay extreme attention to the insertion depth of the distal end of the treatment instrument body. Therefore, a safe procedure can be performed without being influenced by the skill of the surgeon, and the burden on the surgeon can be reduced as much as possible.

Further, in the submucosal layer exfoliation treatment instrument set, the auxiliary device includes a bending auxiliary member having a cross-sectional characteristic that bends in a predetermined constant direction at least on a distal end side of the insertion portion main body, More preferably, the bending direction is the same direction .

In the submucosal layer peeling treatment instrument set, it is more preferable that the auxiliary device has a spherical tip at the tip of the insertion portion main body .

In the submucosal layer peeling treatment instrument set, it is more preferable that the auxiliary device includes an index portion that indicates the amount of insertion into the submucosal layer in the treatment instrument body .

A submucosal layer peeling treatment instrument system according to the present invention includes the submucosal layer peeling treatment instrument set described above and an endoscope having a channel through which the treatment instrument body is inserted .

Further, in the submucosal layer peeling treatment instrument system, the endoscope includes a second channel, and includes a submucosal local injection needle that is inserted into the second channel and injects a liquid into the submucosa. More preferably.

In the submucosal layer peeling treatment instrument system, it is more preferable that the endoscope includes a second channel, and includes grasping forceps that are inserted through the second channel and grip the lesioned part. .

  According to the submucosal layer peeling treatment tool set according to the present invention, the submucosal layer can be peeled without using a conventional high-frequency knife, and the procedure can be facilitated to shorten the procedure time. Moreover, a safe procedure can be performed without being influenced by the skill of the surgeon, and the influence on the surgeon can be reduced as much as possible.

  Further, according to the submucosal layer peeling treatment instrument system according to the present invention, the insertion route is inserted through the channel in a timely manner while alternately replacing the insertion device body of the auxiliary device and the treatment tool body of the submucosal peeling treatment tool. Can be penetrated and the submucosa can be peeled off.

Hereinafter, a first embodiment of a submucosal layer peeling treatment tool set and a submucosal layer peeling treatment tool system according to the present invention will be described with reference to FIGS.
As shown in FIG. 1, a submucosal layer peeling treatment instrument system 1 according to the present embodiment includes a submucosal layer peeling treatment instrument set 2 and an endoscope 5 having an insertion portion 4 provided with a treatment instrument channel (channel) 3. And a submucosal local injection needle 6. The treatment instrument channel 3 can be separately inserted through a submucosal local injection needle 6, an insertion portion main body 10 described later, and a treatment instrument main body 25.

The submucosa peeling treatment tool set 2 is for locally peeling the submucosa W and excising the lesion X of the digestive tract. The auxiliary device 7 and the peeling balloon (submucosal peeling treatment tool) 8 It consists of and.
As shown in FIGS. 2 to 5, the auxiliary device 7 penetrates the submucosal layer W through an insertion route R having a predetermined size, and includes a flexible insertion portion main body 10, and the insertion portion main body 10. A bending conduit (duct) 11 formed from the base end side to the distal end side, an operation wire (wire) 12 inserted into the bending conduit 11 with the distal end fixed, and An operation portion 13 that is fixed to the proximal end side of the operation wire 12 and that pushes and pulls the operation wire 12 with respect to the insertion portion main body 10 to bend the insertion portion main body 10 in a predetermined direction, and at least the distal end of the insertion portion main body 10 On the side, a plate member (curvature assisting member) 14 having a cross-sectional characteristic that curves in a predetermined direction is provided.

  The insertion portion main body 10 is a long tubular body that is inserted into the treatment instrument channel 3, and the operation portion main body 15 of the operation portion 13 is connected to the proximal end side thereof. A spherical distal end portion 16 is attached to the distal end of the insertion portion main body 10. As shown in FIG. 3, the bending conduit 11 is formed at a position shifted from the axis L of the insertion portion main body 10 (a position slightly distant from the insertion portion main body 10) to the proximal end side of the operation portion main body 15. Is formed. The distal end of the operation wire 12 inserted into the bending conduit 11 is fixed to the distal end portion 16.

  As shown in FIG. 2, the operation unit 13 includes the operation unit main body 15 and a slide unit 17 that can move back and forth (slide) with respect to the operation unit main body 15. Then, the proximal end side of the operation wire 12 is connected to the slide portion 17. Thus, when the operation portion 13 is pushed and pulled, that is, when the slide portion 17 is advanced and retracted, the insertion portion main body 10 is bent in a predetermined direction. This will be described in detail later.

  Further, a finger ring 15a through which a thumb can be inserted is attached to the base end side of the operation unit body 15, and two finger hook holes 17a into which an index finger and a middle finger can be inserted are formed in the slide unit 17. Thus, the surgeon can easily operate the operation portion 13 with one hand to bend the insertion portion main body 10.

Further, as shown in FIG. 4, a plurality of communication holes 18 that communicate the bending conduit 11 with the outside are formed on the proximal end side of the distal end portion 16 along the axis L. Since a part of the insertion portion main body 10 is missing due to the plurality of communication holes 18, it is easier to bend than the other portions. In other words, the plurality of communication holes 18 function as flexible portions having more flexibility than other portions. As a result, when the operation unit 13 is pushed and pulled, the distal end side is more easily bent around the area where the plurality of communication holes 18 are formed.
That is, when the slide portion 17 is pulled toward the base end side of the operation portion main body 15, the insertion portion main body 10 is curved toward the plurality of communication holes 18 (UP direction), and the slide portion 17 is moved to the operation portion main body 15. When the push-in operation is performed on the distal end side, the insertion portion main body 10 is curved toward the opposite side (DOWN direction) of the plurality of communication holes 18 side.

As shown in FIGS. 3 and 4, the plate member 14 is formed in a long and narrow shape with a stainless material. The plate member 14 has a cross-sectional characteristic that is curved in advance in the thickness direction (a constant direction), and the thickness direction is operated with the axis L at a position opposite to the bending conduit 11 across the axis L. It is provided so as to coincide with the direction connecting the wire 12. As a result, the direction in which the plate member 14 bends matches the direction in which the plate member 14 bends when the operation unit 13 is pushed and pulled.
In the present embodiment, the plate member 14 is pushed into the plate member conduit 19 formed in the insertion portion main body 10 from the distal end side, and the plate member tube is caused by frictional force with the plate member conduit 19. It is held in the path 19. The front end of the plate member conduit 19 is sealed by a sealing portion 20.

  Further, as shown in FIG. 5, the insertion portion main body 10 on the proximal end side with respect to the distal end portion 16 is provided with an index portion 20 that indicates the amount of insertion into the submucosa W. The indicator portion 20 is marked at an interval of 5 mm from the distal end portion 16 toward the proximal end side of the insertion portion main body 10.

As shown in FIGS. 6 to 9, the peeling balloon 8 includes a flexible treatment instrument body 25 that is inserted into the submucosa W along the insertion route R that is pierced by the auxiliary device 7, and When the fluid conduit 26 formed from the proximal end side to the distal end side of the treatment instrument body 25 and the distal end side of the treatment instrument body 25 are supplied with fluid through the fluid conduit 26 And a balloon (inflatable portion) 27 that is inflated.
On the proximal end side of the treatment instrument body 25, an injection port 28 communicating with the fluid conduit 26 is provided. The distal end portion 29 of the treatment instrument body 25 is formed in a taper shape in which the outer diameter gradually decreases toward the forefront. The balloon 27 is provided on the proximal end side of the distal end portion 29 so as to cover the outer periphery of the treatment instrument body 25. A communication hole 30 for communicating the fluid conduit 26 with the balloon 27 is formed on the side surface of the treatment instrument body 25 covered with the balloon 27. Further, the tip of the fluid conduit 26 is sealed by a sealing portion 31, and the fluid supplied into the fluid conduit 26 does not leak from the tip of the fluid conduit 26, so that the communication hole 30 is passed through. Thus, the air is reliably supplied into the balloon 27.

  Further, an insertion passage 36 through which the high-frequency knife (high-frequency cutting tool) 35 can be inserted is formed in the treatment instrument body 25 along the bending conduit 11. The high-frequency knife 35 is inserted into the insertion passage 36 and has an operation tube 37 made of an insulating material formed in a tubular shape, and a high-frequency knife 38 that is disposed in the operation tube 37 so as to be able to advance and retract and is formed in a needle shape. And a knife operation section 39 connected to the proximal end side of the operation tube 37.

As shown in FIG. 6, the knife operation unit 39 is connected to the knife operation unit main body 40 connected to the proximal end side of the operation tube 37 and the proximal end side of the high-frequency knife 38, and is connected to the knife operation unit main body 40. And a knife slide portion 41 which can be advanced and retracted. Similarly to the operation unit 13 described above, a finger hook ring 40a capable of inserting a thumb is attached to the proximal end side of the knife operation unit main body 40, and an index finger and a middle finger can be inserted into the knife slide unit 41. Two finger hooking holes 41a are formed. As a result, the operator can easily operate the knife operation unit 39 with one hand.
Furthermore, an electrical connection part 42 electrically connected to the high-frequency knife 38 is provided between the two finger hooking holes 41 a of the knife slide part 41, and a high-frequency power source (not shown) for applying a high frequency to the high-frequency knife 38 It can be connected electrically.

  Further, as shown in FIG. 9, the treatment instrument body 25 on the proximal end side with respect to the balloon 27 is provided with an indicator portion 42 that indicates the amount of insertion into the submucosa W. The indicator portion 42 is marked at an interval of 5 mm from the distal end portion 29 toward the proximal end side of the treatment instrument main body 25.

As shown in FIG. 10, the submucosal local injection needle 6 is formed in a hollow shape by being attached to an outer tube 50, an inner tube 51 that can advance and retreat in the outer tube 50, and a tip of the inner tube 51. A needle portion 52 and a needle operation portion 53 attached to the proximal end side of the outer tube 50.
The distal end of the outer tube 50 is formed in a jaw shape protruding radially inward, and only the needle portion 52 of the inner tube 51 is inserted. The needle operation unit 53 is attached to the proximal end side of the inner tube 51 and the needle operation unit main body 54 attached to the proximal end side inner peripheral surface of the outer tube 50, and is a liquid for local injection (local injection solution). And a base 55 for injecting the liquid. The needle portion 52 can be protruded outward from the distal end of the outer tube 50 by moving the base 55 forward and backward with respect to the needle operation portion main body 54.

Next, the submucosal layer peeling method for excising the lesion X in the digestive tract from the submucosal layer W using the submucosal layer peeling tool set 2 and the submucosal layer peeling tool system 1 configured as described above will be described below. Explained.
The submucosal layer peeling method of this embodiment includes a bulging step for bulging the submucosal layer W around the lesioned part X, a drilling step for opening the insertion hole H in the mucous membrane N near the bulged lesioned part X, and insertion into the insertion hole H. An insertion step for inserting only the distal end of the main body 10, an adjustment step for curving the insertion main body 10 and adjusting the bending angle so that the distal end of the insertion main body 10 is parallel to the surface of the digestive tract; A main body 10 is moved in a direction parallel to the surface of the digestive tract and pushed through the insertion hole H into the submucosal layer W to penetrate the submucosal layer W through the insertion route R of a predetermined size; Length adjustment step of inserting the treatment tool body 25 and pushing the treatment tool body 25 into the submucosa W along the insertion route R and aligning the distal end position of the treatment tool body 25 with a predetermined position of the submucosa W When, Fluid is supplied to expand the Loon 27 includes a peeling step of peeling the submucosal layer is W, the the incision step of dissecting the mucosa N around the insertion hole H.
Each of these steps will be described in detail below.

First, a swelling step is performed. That is, after the submucosal local injection needle 6 shown in FIG. 10 is inserted into the treatment instrument channel 3, the insertion portion 4 is inserted into the digestive tract, and the distal end of the insertion portion 4 is positioned in the vicinity of the lesion X. In this state, the outer tube 50 of the submucosal injection needle 6 is protruded from the distal end of the insertion portion 4, and the base 55 is moved toward the distal end side with respect to the needle operation portion main body 54, as shown in FIG. Thus, the needle part 52 is protruded from the tip of the outer tube 50. Then, as shown in FIG. 11, the needle portion 52 is punctured from the mucosa N in the vicinity of the lesion X into the submucosa W. After puncturing, the local injection solution is injected into the submucosal layer W through the inner tube 51 and the needle portion 52 to bulge the lesion X.
After swelling of the lesioned part X, the base 55 is moved to the proximal end side so that the needle part 52 is immersed in the inner tube 51 and the submucosal injection needle 6 is removed from the treatment instrument channel 3. Note that the endoscope 5 is not moved and is maintained at the same position.

After the bulging step, a drilling step is performed. That is, the separation balloon 8 shown in FIG. 6 is inserted into the treatment instrument channel 3 and the distal end of the treatment instrument body 25 is projected from the distal end of the insertion portion 4. Then, the knife slide portion 41 is moved to the distal end side with respect to the knife operation portion main body 40, and the high frequency knife 38 is protruded from the operation tube 37 and the distal end portion 29. In this state, while applying a high frequency from a high frequency power source connected to the electrical connection portion 42, as shown in FIG. 12, the high frequency knife 38 is advanced to insert the insertion hole of a predetermined size into the mucous membrane N near the lesion X. Open H.
After opening the insertion hole H, the application of high frequency is stopped, and the knife slide portion 41 is moved to the proximal end side so that the high frequency knife 38 is immersed in the operation tube 37.

After the drilling step, an insertion step is performed. First, the peeling balloon 8 is removed from the treatment instrument channel 3, and the insertion portion main body 10 of the auxiliary device 7 is inserted into the treatment instrument channel 3 so that the distal end protrudes.
Here, since the plate member 14 is provided on the distal end side of the insertion portion main body 10, the auxiliary device 7 automatically follows the bending angle of the insertion portion 4 when moving in the treatment instrument channel 3. Moving. And when it protrudes from the front-end | tip of the insertion part 4, the curve direction (up-down direction) of the insertion part 4 and the thickness direction of the board member 14 correspond. Here, since the thickness direction of the plate member 14 is provided so as to coincide with the bending direction of the auxiliary device 7, as a result, simply inserting the auxiliary device 7 into the treatment instrument channel 3 naturally causes the insertion portion 4 to be inserted. The bending direction can be aligned in the same direction as the bending direction.
In the present embodiment, description will be made assuming that the side on which the operation wire 12 and the plurality of communication holes 18 are formed is located on the upper position side of the insertion portion 4.

  Then, as shown in FIG. 13, only the distal end portion 16 of the insertion portion main body 10 is inserted into the insertion hole H. At the stage of this insertion step, the distal end side of the insertion portion main body 10 is in a state in which an angle θ is attached to the surface of the digestive tract as in the prior art.

  After this insertion step, an adjustment step is performed. That is, the operating portion 12 is pulled by moving the slide portion 17 to the proximal end side with respect to the operating portion main body 15. At this time, since the distal end of the operation wire 12 is fixed by the distal end portion 16, the tensile force transmitted to the operation wire 12 by the pulling operation is transmitted to the insertion portion main body 10. Thereby, a compressive force acts on the insertion portion main body 10 on the side close to the operation wire 12 and a tensile force acts on the opposite side of the operation wire 12 with the shaft core L interposed therebetween. As a result, as shown in FIG. 14, the insertion portion main body 10 bends and curves toward the operation wire 12 side, that is, the upper side of the insertion portion 4. In particular, since a plurality of communication holes 18 that are flexible portions are formed, the curved portion is bent around a region where the communication holes 18 are formed. Therefore, the distal end of the insertion portion main body 10 is more actively curved.

  In addition, when the slide portion 17 is moved to the distal end side with respect to the insertion portion main body 10 and the operation wire 12 is pushed in, the force acting on the insertion portion main body 10 acts in reverse to the case described above. The tip is bent and bent toward the lower side of the insertion portion 4.

  By the adjustment step, even in a limited space inside the digestive tract, the bending state can be adjusted so that the distal end side of the insertion portion main body 10 is parallel to the surface of the digestive tract. In particular, the plate member 14 can be quickly operated in the same direction as the bending direction of the insertion portion 4 of the endoscope 5 without adjusting the bending direction.

And a penetration step is performed after an adjustment step. That is, as shown in FIG. 15, the insertion portion main body 10 is moved in a direction parallel to the surface of the digestive tract and pushed into the submucosa W from the insertion hole H. Accordingly, as shown in FIG. 16, an insertion route R having a predetermined size corresponding to the outer diameter of the insertion portion main body 10 can be penetrated through the submucosa W. At this time, since the index portion 20 is marked at intervals of 5 mm in the insertion portion main body 10, the insertion route R having a desired depth can be penetrated with high accuracy. By this penetration step, it is possible to secure an insertion route R that is penetrated in a direction parallel to the surface of the digestive tract.
In addition, since the distal end of the insertion portion main body 10 is a spherical distal end portion 16, even if the distal end of the insertion portion main body 10 comes into contact with the intrinsic muscle layer W1 or the like below the submucosa W during the penetration step. Therefore, it is difficult to affect the inherent muscle layer W1 such as a wound, and the safety of the procedure can be improved.

  After the penetration step, a length adjustment step is performed. First, the auxiliary device 7 is removed from the treatment instrument channel 3, and the treatment instrument main body 25 of the peeling balloon 8 is inserted again to protrude the tip. Then, as shown in FIG. 17, the treatment instrument body 25 is inserted into the insertion route R pierced by the auxiliary device 7, and the treatment instrument body 25 is pushed into the submucosa W along the insertion route R. The tip position of the instrument body 25 is aligned with a predetermined position of the submucosa W. At this time, since the treatment instrument body 25 moves along the insertion route R, it is inserted into the submucosa W in a state parallel to the surface of the digestive tract. In addition, since the indicator portions 42 are marked at intervals of 5 mm from the proximal end side of the balloon 27 on the treatment instrument body 25, alignment can be performed with high accuracy.

And a peeling step is performed after an adjustment step. That is, the fluid is supplied from the inlet 28 into the fluid conduit 26. The supplied fluid passes through the fluid conduit 26 and is supplied from the communication hole 30 into the balloon 27. Thereby, as shown in FIG. 18, the balloon 27 can be inflated, and the submucosa W can be peeled off by the pressure at the time of inflation.
After the submucosal layer W is peeled, the fluid is once discharged from the injection port 28 and the balloon 27 is contracted to the original state. As a result, as shown in FIG. 19, a cavity H <b> 1 from which the submucosa W is peeled is formed in the submucosa W.

  An incision step is performed after the peeling step. That is, the treatment instrument body 25 is pulled back from the inside of the lesion X to the outside of the insertion hole H, and again, as shown in FIG. 20, the high-frequency knife 38 protrudes from the distal end portion 29 of the treatment instrument body 25 as in the drilling step. And inserted into the insertion hole H. In this state, while applying a high frequency to the high frequency knife 38 again, the distal end of the treatment instrument body 25 is moved along the periphery of the lesion X, and the mucosa N around the insertion hole H is moved to the high frequency knife as shown in FIG. An incision is made by 38. Then, after cutting a certain width, the supply of high frequency is stopped and the high frequency knife 38 is accommodated in the operation tube 37.

Subsequently, in order to perform peeling again, the penetration step by the auxiliary device 7 is repeated. That is, as shown in FIG. 22, the insertion portion main body 10 is inserted again while confirming the index portion 20 from the insertion hole H into the submucosal layer W, and the insertion route R is further penetrated from the back of the cavity portion H1. Subsequently, the length adjustment step is repeated again, and as shown in FIG. 23, the treatment instrument body 25 is inserted into the insertion route R penetrated in the re-insertion step while confirming the indicator portion 42. Subsequently, the peeling step is repeated again, and as shown in FIG. 24, the balloon 27 is inflated, and the submucosal layer W that has not been peeled off in the first peeling step is peeled off to form the next cavity H1. Thereafter, a second incision step is performed as shown in FIG.
In this way, by repeating the penetration step, the length adjustment step, the peeling step and the incising step according to the size of the lesioned part X in a timely manner, the submucosa W in a wide range can be easily peeled one after another. As shown, the lesioned part X including the submucosa W can be separated from the digestive tract and excised.

As described above, according to the submucosal layer peeling treatment tool set 2 and the submucosal layer peeling treatment tool system 1 of the present embodiment, the insertion unit body 10 of the auxiliary device 7 and the treatment device channel 3 of the endoscope 5; The insertion of the insertion route R and the peeling of the submucosa W can be performed by inserting the peeling balloon 8 with the treatment instrument body 25 alternately while being replaced with time. Therefore, even if the conventional high-frequency knife 35 is not frequently used, the balloon 27 can be inserted into different positions of the submucosa W to peel the submucosa W one after another, and the submucosa W is reliably peeled over a wide range. Therefore, the procedure can be facilitated and the procedure time can be shortened. At this time, even if there is bleeding in the lesioned part X, the bleeding part can be compressed by inflating the balloon 27, the bleeding part can be rapidly stopped, and the submucosal layer W of the lesioned part X can be stopped. The incidental illness which accompanies can be prevented beforehand.
Moreover, since the treatment instrument channel 3 can be shared and used, the diameter of the insertion portion 4 of the endoscope 5 can be reduced.

  In particular, since the treatment instrument body 25 is inserted into the submucosa W along the insertion route R previously penetrated by the auxiliary device 7, the treatment instrument body 25 is placed on the intrinsic muscle layer W1 or the like below the submucosa W as in the prior art. There is no possibility that the tip side of will be inserted. Therefore, it is not necessary to pay extreme attention to the insertion depth at the distal end of the treatment instrument body 25. Therefore, a safe procedure can be performed without being affected by the skill of the operator, and the burden on the operator can be reduced as much as possible.

  Moreover, since the some communication hole 18 which functions as a flexible part is formed in the front end side of the insertion part main body 10, the insertion part main body 10 can be bent more actively at the front end side. Thereby, even if the amount of projection of the endoscope 5 from the treatment instrument channel 3 is small, the bending operation can be performed reliably, and even if the procedure space in the digestive tract is narrow, a reliable procedure is possible. It can be performed.

  Further, when the auxiliary device 7 protrudes from the distal end of the insertion portion 4 of the endoscope 5 by the plate member 14, the bending direction of the endoscope 5 and the bending direction of the auxiliary device 7 automatically match. Thus, the surgeon can quickly perform a bending operation in the same direction as the bending direction of the endoscope 5 without adjusting the bending direction. Therefore, the labor for adjusting the bending direction can be saved, and the time required for the peeling of the submucosa W can be further shortened.

Further, since the spherical distal end portion 16 is provided at the distal end of the insertion portion main body 10, when the insertion route R is penetrated, the distal end of the insertion portion 4 is temporarily placed on the intrinsic muscle layer W 1 below the submucosa W. Even if contact is made, it is difficult to damage the proper muscle layer W1 and the like. Therefore, the safety of the procedure can be further increased.
Furthermore, since the index portion 20 is marked, the insertion amount of the insertion portion main body 10 into the submucosal layer W can be accurately grasped, and the treatment instrument main body 25 that is subsequently inserted into the insertion route R is attached to the submucosal layer W. It can be accurately positioned at a predetermined position. As a result, the desired portion of the submucosa W can be accurately peeled off.

Next, a second embodiment of the submucosa peeling treatment tool set and the submucosal peeling treatment tool system according to the present invention will be described with reference to FIGS. In the second embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted.
The difference between the second embodiment and the first embodiment is that the submucosal layer peeling treatment instrument system 1 of the first embodiment is different from the auxiliary device 7 inserted through the treatment instrument channel 3 of the endoscope 5 separately. Although the submucosal layer peeling treatment instrument set 2 including the peeling balloon 8 is provided, the submucosal layer peeling treatment tool system 60 of the second embodiment includes a peeling balloon 61 inserted into the treatment tool channel 3 of the endoscope 5 and A submucosal layer peeling treatment instrument set 63 including an auxiliary device 62 inserted through the peeling balloon 61 is provided.
Furthermore, the auxiliary device 7 of the first embodiment is configured to bend in a predetermined direction based on a bending operation by the operation unit 13, whereas the auxiliary device 62 of the second embodiment has a certain amount or more from the outside. It is a point that curves in a predetermined direction when receiving a force.

That is, as shown in FIG. 27, the submucosal layer peeling treatment instrument system 60 of this embodiment includes a submucosal layer peeling treatment instrument set 63, an endoscope 5, and a submucosal local injection needle 6. The treatment instrument channel 3 can be inserted through the submucosal injection needle 6 and the treatment instrument body 25 of the peeling balloon 61 separately.
The submucosal layer peeling treatment tool set 63 is for locally peeling the submucosal layer W and excising the lesion X of the digestive tract. The auxiliary device 62 shown in FIGS. 28 to 31 and FIG. And a peeling balloon (mucosal layer peeling treatment tool) 61 shown in FIG.

  As shown in FIGS. 28 to 31, the auxiliary device 62 penetrates the insertion route R of a predetermined size into the submucosa W of the lesion X, and is inserted into the insertion conduit 80 of the peeling balloon 61. The flexible insertion portion main body 70 is provided, and is provided on the distal end side of the insertion portion main body 70. The insertion portion main body 70 is more flexible than the other portions and bends in a predetermined direction when receiving a certain amount of force from the outside. A flexible portion 71, a pair of forceps pieces 72 provided at the distal end of the insertion portion main body 70, and a forceps piece operation portion 73 for opening and closing the pair of forceps pieces 72 on the proximal end side of the insertion portion main body 70. It has.

The insertion portion main body 70 is a long tubular body, a distal end cover 74 for fixing the pair of forceps pieces 72 to be freely opened and closed is attached to the distal end side, and the operation of the forceps piece operating portion 73 is disposed on the proximal end side. A part main body 75 is attached. Further, the length of the insertion portion main body 70 is longer than the length of the insertion conduit 80 of the peeling balloon 62.
The pair of forceps pieces 72 are pin-coupled to the tip cover 74 and connected to the operation wire 76 via a link mechanism. That is, the operation wire 76 is opened and closed by a push-pull operation.
The forceps piece operation portion 73 includes the operation portion main body 75 and a slide portion 77 attached to the operation portion main body 75 so as to be movable forward and backward. The proximal end side of the operation wire 76 is connected to the slide portion 77. That is, by moving (sliding) the slide portion 77 toward the proximal end side of the insertion portion main body 70, the operation wire 76 is pulled and the pair of forceps pieces 72 are closed as shown in FIG. By moving to the front end side of the main body 70, the operation wire 76 is pushed and the pair of forceps pieces 72 are opened as shown in FIG.

  Further, a finger ring 75a into which a thumb can be inserted is attached to the proximal end side of the operation unit body 75, and a recess 77a is formed in the center portion of the slide unit 77 so that the index finger and the middle finger can be hooked at the same time. Has been. Thus, the surgeon can easily open and close the pair of forceps pieces 72 with one hand.

In addition, the insertion portion main body 70 is shaved so that the outer periphery of the insertion portion main body 70 faces only across a certain axis from the proximal end side on the distal end side with the axis L interposed therebetween. Thereby, as shown in FIG. 30, the insertion portion main body 70 is easily bent in the direction in which the surfaces are opposed (α direction), and is difficult to bend in the direction orthogonal to this (β direction). In other words, the region cut to have the opposing surface functions as the flexible portion 71. The flexible portion 71 is curved in the α direction when receiving a certain force from the outside. In the present embodiment, it is set so as to be bent by the repulsive force received when it contacts the proper muscle layer W1 under the submucosa W.
This bending direction is a direction orthogonal to the opening / closing direction of the pair of forceps pieces 72.

  The peeling balloon 61 is formed from the proximal end side to the distal end side of the treatment instrument body 25 along the fluid conduit 26 as shown in FIGS. 32 and 33, and the insertion portion body 70 of the auxiliary device 62. The insertion pipe line 80 is inserted. An insertion port 81 for inserting the auxiliary device 62 is attached to the proximal end side of the insertion conduit 80.

Next, the submucosal layer peeling method for excising the lesion X formed in the digestive tract from the submucosa layer W using the submucosal layer peeling tool set 63 and the submucosal layer peeling tool system 60 configured as described above will be described below. Explained.
The submucosal layer peeling method of this embodiment includes a bulging step for bulging the submucosal layer W around the lesioned part X, a drilling step for opening the insertion hole H in the mucous membrane N near the bulged lesioned part X, and insertion into the insertion hole H. A penetration step of inserting the main body 70 and penetrating the insertion route R of a predetermined size into the submucosa W, and inserting the treatment tool body 25 into the insertion route R, and along the insertion route R, the submucosa W The treatment tool body 25 is pushed into the length, the length adjustment step of aligning the distal end position of the treatment tool body 25 with a predetermined position of the submucosa W, and a fluid is supplied to the balloon 27 to inflate, and the submucosa W is peeled off. And an incision step for incising the mucous membrane N around the insertion hole H. When the insertion portion main body 70 comes into contact with the intrinsic muscle layer W1 below the submucosa W during the penetration step, the step is flexible. Part 71 Curved receiving a predetermined force or more, in the submucosal layer W, the insertion route R oriented in a direction parallel to the surface of the digestive tract are those penetration.
Each step will be described in detail below.

First, as in the first embodiment, a submucosal injection needle 6 is inserted into the treatment instrument channel 3 of the endoscope 5 to perform a bulging step for bulging the lesion X. Then, after the lesioned part X is expanded, the submucosal injection needle 6 is removed from the treatment instrument channel 3.
Next, as shown in FIG. 27, the treatment instrument body 25 of the peeling balloon 61 in which the insertion section body 70 of the auxiliary device 62 is inserted into the insertion conduit 80 is inserted into the treatment instrument channel 3. Thereafter, a punching step is performed by the high frequency knife 38 as in the first embodiment.
After the drilling step, the insertion portion main body 70 of the auxiliary device 62 is further pushed into the insertion conduit 80, and the distal end of the insertion portion main body 70 is projected from the distal end of the treatment instrument main body 25 as shown in FIG. At this time, the orientation of the flexible portion 71 is adjusted to an appropriate direction shown in FIG. 34 (that is, the α direction described above is a direction parallel to the paper surface) so that the insertion portion main body 70 is curved upward. Protruding in the state.

Next, an insertion step is performed. That is, as shown in FIG. 35, the insertion portion main body 70 is inserted into the submucosa W from the insertion hole H. When the insertion starts, the insertion portion main body 70 advances through the submucosal layer W with an angle θ with respect to the surface of the digestive tract as in the conventional case. That is, the process proceeds toward the proper muscle layer W1 below the submucosa W.
Then, as shown in FIG. 36, when the pair of forceps pieces 72 provided at the distal end of the insertion portion main body 70 come into contact with the proper muscle layer W1 below the submucosa W, the proper muscle layer W1 becomes more submucosa W. Since it is harder, the insertion portion main body 70 is bent upward due to the cross-sectional characteristics of the flexible portion 71 due to the repulsive force from the intrinsic muscle layer W1. The insertion portion main body 70 advances through the submucosal layer W in a direction along the surface of the proper muscle layer W1 (the surface of the digestive tract) after making contact with the proper muscle layer W1 due to this curvature. As a result, even in a limited space in the digestive tract, the lower mucosa W was penetrated in a predetermined size according to the outer diameter of the insertion portion main body 70 and in a direction parallel to the surface of the digestive tract. The insertion route R can be secured.

  In particular, when performing this insertion step, as shown in FIG. 37, when the slide portion 77 is pushed and pulled with respect to the operation portion main body 75 to open and close the pair of forceps pieces 72, the insertion route R is penetrated. good. By doing so, the insertion route R can be penetrated while spreading the submucosa W with the pair of forceps pieces 72, and the insertion route R can be ensured more reliably.

After the penetration step, a length adjustment step is performed. That is, the treatment instrument body 25 of the peeling balloon 61 is pushed into the treatment instrument channel 3 without moving the auxiliary device 62 from the current position. As a result, the treatment instrument body 25 moves along the insertion route R and is inserted into the submucosa W, and the insertion portion body 70 of the auxiliary device 62 is immersed in the insertion conduit 80 of the treatment instrument body 25. .
At this time, since the treatment instrument body 25 moves along the insertion route R, it is inserted into the submucosa W in a state parallel to the surface of the digestive tract. In addition, since the indicator portion 42 is marked at intervals of 5 mm from the proximal end side of the balloon 27 on the treatment instrument body 25, accurate length adjustment is performed so that the distal end is positioned at a predetermined position in the submucosa W. It can be carried out.

  Further, when performing this length adjustment step, as shown in FIG. 38, the treatment is performed as shown in FIG. 39 with the innermost submucosal layer W of the insertion route R held by the pair of forceps pieces 72 as shown in FIG. The tool body 25 may be pushed into the insertion route R. By carrying out like this, the treatment tool main body 25 can be reliably inserted to the innermost part of the insertion route R, and it can lead to a more exact peeling operation | work.

  Then, after the adjustment step, the peeling step is performed similarly to the first embodiment, and the submucosa W is peeled off. Thereafter, an incision step is performed as in the first embodiment. Thereafter, by repeating the above-described penetration step, length adjustment step, peeling step and incision step according to the size of the lesion X, the submucosa W in a wide range can be easily peeled one after another. The lesioned part X can be separated from the digestive tract and excised.

As described above, according to the submucosal layer peeling treatment tool set 63 and the submucosal layer peeling treatment tool system 60 of the present embodiment, the treatment tool body 25 is moved along the insertion route R previously penetrated by the auxiliary device 62. Therefore, as in the first embodiment, there is no possibility that the tip is inserted into the intrinsic muscle layer W1 or the like below the submucosa W. Therefore, a safe procedure can be performed without being influenced by the skill of the surgeon, and the burden on the surgeon can be reduced as much as possible.
Furthermore, since the insertion portion main body 70 of the auxiliary device 62 can be inserted into the digestive tract using the insertion conduit 80 of the peeling balloon 61, it is not necessary to replace the auxiliary device 62 and the peeling balloon 61. Therefore, the procedure time can be further shortened.
In addition, since the auxiliary device 62 of the present embodiment includes the pair of forceps pieces 72, the reliability of the insertion route R is increased, and the treatment tool body 25 is inserted into the insertion route without changing the distal end position of the insertion portion body 70. It can be inserted into R, and length adjustment can be facilitated.

  The technical scope of the present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the present invention.

For example, in the first embodiment, the bending angle is adjusted after inserting only the distal end of the insertion portion main body 10 into the insertion hole H. However, after the bending angle is adjusted first, the insertion portion main body 10 is placed in the submucosa W. You can insert it.
Moreover, in the said 1st Embodiment, although the auxiliary device 7 was provided with the spherical front-end | tip part 16, you may be provided with a pair of forceps piece 72 like 2nd Embodiment. In contrast, the auxiliary device 62 according to the second embodiment includes the pair of forceps pieces 72, but may include the spherical tip portion 16 as in the first embodiment.

Further, in each of the above embodiments, the submucosal layer peeling treatment instrument system 1, 60 is configured by the endoscope 5 having one treatment instrument channel 3. However, the present invention is not limited to this, and for example, in addition to the treatment instrument channel 3 An endoscope having a second treatment instrument channel (second channel) provided in the insertion section 4 along the treatment instrument channel 3 and the second treatment instrument channel are inserted into the submucosa W The submucosa peeling treatment instrument system may be configured by the submucosal local injection needle 6 for injecting the liquid and the submucosa peeling treatment instrument set 2 including the peeling balloon 8 and the auxiliary device 7 of the first embodiment.
According to the submucosal layer exfoliation treatment instrument system configured as described above, the exfoliation balloon 8 or the auxiliary device 7 and the submucosal injection needle 6 can be inserted into the digestive tract together. After performing the bulge of X, it is possible to promptly shift to the peeling treatment without replacing the treatment tool. Therefore, the time taken to peel the submucosa W from the swelling of the lesioned part X can be shortened.

Further, instead of the submucosal local injection needle 6 described above, a submucosal detachment treatment instrument system including grasping forceps that are inserted into the second treatment instrument channel and grasp the lesion X may be configured.
In this case, since the grasping forceps can be inserted into the digestive tract together with the separation balloon 8 or the auxiliary device 7 through the second treatment instrument channel, the mucous membrane can be peeled while the lesion X is gripped. Therefore, without being affected by the already-exfoliated lesion X, the balloon 27 is accurately inserted into the submucosa W, or the submucosa W is securely exfoliated while firmly grasping so that the lesion X does not escape. Can be done. Therefore, a more accurate procedure can be performed.

  Moreover, you may comprise a submucosa peeling treatment tool set with the peeling balloon 61 of the said 2nd Embodiment, and the auxiliary device 7 of 1st Embodiment. By doing so, the auxiliary device 7 can be easily introduced into the body cavity via the insertion passage 80 of the peeling balloon 61, so that the trouble of replacing the peeling balloon 8 and the auxiliary device 7 in the first embodiment can be reduced. It can be omitted. Other functions and effects are the same as those of the first embodiment.

Moreover, this invention includes the following.
[Additional Item 1]
A submucosal layer exfoliation method that uses the submucosal layer exfoliation treatment instrument set according to any one of claims 1 to 5 to locally exfoliate the submucosal layer W and excise a lesion in the digestive tract,
A swelling step for swelling the submucosal layer around the lesion;
A drilling step for opening an insertion hole in the mucosa in the vicinity of the bulging lesion;
An insertion step of inserting only the tip of the insertion portion main body into the insertion hole;
An adjustment step of bending the insertion portion main body and adjusting a bending angle so that a distal end of the insertion portion main body is parallel to the surface of the digestive tract;
A penetration step of moving the insertion portion body in a direction parallel to the surface of the digestive tract and pushing it into the submucosal layer from the insertion hole to penetrate an insertion route of a predetermined size in the submucosal layer;
Length adjustment for inserting the treatment instrument body into the insertion route, pushing the treatment tool body into the submucosa along the insertion route, and aligning the distal end position of the treatment tool body with a predetermined position of the submucosa Steps,
A peeling step of supplying a fluid to the inflating part to inflate and peeling off the submucosal layer;
An incision step for incising the mucous membrane around the insertion hole.

[Appendix 2]
A submucosal layer exfoliation method in which the submucosal layer exfoliation treatment tool set according to any one of claims 1 to 5 is used to locally exfoliate the submucosal layer W to excise a lesion in the digestive tract,
A swelling step for swelling the submucosal layer around the lesion;
A drilling step for opening an insertion hole in the mucosa in the vicinity of the bulging lesion;
Adjustment that adjusts the bending angle so that the distal end of the insertion portion main body is parallel to the surface of the digestive tract after the insertion portion main body is bent after the distal end of the insertion portion main body is positioned in the vicinity of the insertion hole Steps,
A penetration step of moving the insertion portion body in a direction parallel to the surface of the digestive tract and pushing it into the submucosal layer from the insertion hole to penetrate an insertion route of a predetermined size in the submucosal layer;
Length adjustment for inserting the treatment instrument body into the insertion route, pushing the treatment tool body into the submucosa along the insertion route, and aligning the distal end position of the treatment tool body with a predetermined position of the submucosa Steps,
A peeling step of supplying a fluid to the inflating part to inflate and peeling off the submucosal layer;
An incision step for incising the mucous membrane around the insertion hole.

[Additional Item 3]
A submucosal layer exfoliation method that uses the submucosal layer exfoliation treatment instrument set according to any one of claims 12 to 14 to locally exfoliate the submucosa layer and excise a lesion in the digestive tract,
A swelling step for swelling the submucosal layer around the lesion;
A drilling step for opening an insertion hole in the mucosa in the vicinity of the bulging lesion;
A penetration step of inserting the insertion portion main body into the insertion hole and penetrating an insertion route of a predetermined size into the submucosal layer;
Length adjustment for inserting the treatment instrument body into the insertion route, pushing the treatment tool body into the submucosa along the insertion route, and aligning the distal end position of the treatment tool body with a predetermined position of the submucosa Steps,
A peeling step of supplying a fluid to the inflating part to inflate and peeling off the submucosal layer;
An incision step for incising the mucous membrane around the insertion hole,
During the penetration step, when the insertion portion main body comes into contact with the lower layer of the submucosa, the flexible portion receives a certain level of force and curves, and in the submucosa, in a direction parallel to the surface of the digestive tract A method of exfoliating the submucosa, wherein the insertion route facing is penetrated.

It is a block diagram of 1st Embodiment of the submucosa peeling treatment tool system and submucosa peeling treatment tool set concerning this invention. It is a block diagram of the auxiliary device which is a component of the submucosa peeling treatment tool set shown in FIG. FIG. 3 is a cross-sectional arrow view AA shown in FIG. 2. It is a cross-sectional arrow BB figure shown in FIG. It is a figure which shows the parameter | index part marked on the insertion part main body of the auxiliary device shown in FIG. It is a block diagram of the submucosa peeling treatment tool which is a component of the submucosa peeling treatment tool set shown in FIG. It is sectional drawing to which the balloon periphery of the submucosa peeling treatment tool shown in FIG. 6 was expanded. It is CC sectional view taken on the line in FIG. It is a figure which shows the parameter | index part marked on the treatment tool main body of the submucosa peeling treatment tool shown in FIG. It is sectional drawing of the submucosal local injection needle which is a component of the submucosa peeling treatment instrument system shown in FIG. 1, (a) is a figure which shows the state which the needle part protruded from the outer tube, (b) is a needle | hook. It is a figure which shows the state which the part immersed in the inner tube. It is a figure which shows each process of the submucosa exfoliation method which excises a lesioned part by the submucosa exfoliation treatment instrument system and submucosa exfoliation treatment instrument set shown in FIG. 1, Comprising: It is a figure which shows the state which caused the lesion part to bulge. FIG. 12 is a diagram showing each step of a submucosal layer peeling method for excising a lesion site with the submucosal layer peeling treatment instrument system and submucosal layer peeling treatment tool set shown in FIG. 1, after the state shown in FIG. It is a figure which shows the state which opened the insertion hole with the high frequency knife. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: After the state shown in FIG. 12, it assists in an insertion hole. It is a figure which shows the state which inserted only the front-end | tip part of the insertion part main body of a device. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: It is a figure which shows the front-end | tip of an insertion part main body after the state shown in FIG. It is a figure which shows the state which curved the side upwards and adjusted the insertion part main body in the direction parallel to the surface of a digestive tract. It is a figure which shows each process of the submucosa peeling method which excises a lesioned part by the submucosa peeling treatment instrument system and submucosal peeling treatment tool set shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state which inserted in the lower layer and penetrated the insertion route. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment instrument system shown in FIG. 1, and a submucosa peeling treatment tool set, Comprising: The figure which shows the insertion route after the state shown in FIG. It is. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: In the submucosal layer along the insertion route shown in FIG. It is a figure which shows the state which inserted the treatment tool main body. FIG. 18 is a diagram showing each step of a submucosal layer peeling method for excising a lesion site with the submucosal layer peeling treatment instrument system and the submucosal layer peeling treatment tool set shown in FIG. 1, and after the state shown in FIG. It is a figure which shows the state expanded by. FIG. 19 is a diagram showing each step of a submucosal layer peeling method for excising a lesion site with the submucosal layer peeling treatment tool system and the submucosal layer peeling treatment tool set shown in FIG. 1, and after deflating the balloon after the state shown in FIG. 18. It is a figure which shows the state which extracted the treatment tool main body from the submucosa. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state which inserted the knife. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state which cut | disconnected the surrounding mucous membrane. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state which inserted the insertion part main body in the submucosa and penetrated the insertion route. It is a figure which shows each process of the submucosa exfoliation method which excises a lesioned part by the submucosa exfoliation treatment instrument system and submucosa exfoliation treatment instrument set shown in FIG. 1, Comprising: It penetrated newly after the state shown in FIG. It is a figure which shows the state which inserted the treatment tool main body into the submucosa layer again along the insertion route. It is a figure which shows each process of the submucosa peeling method which excises a lesioned part by the submucosa peeling treatment instrument system and the submucosa peeling treatment instrument set shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state expanded in the inside. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment instrument system and submucosal peeling treatment tool set which are shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state which cut | disconnected the mucous membrane around a hole. It is a figure which shows each process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment instrument system and submucosal layer peeling treatment tool set shown in FIG. 1, Comprising: After the state shown in FIG. It is a figure which shows the state excised from the digestive tract in the state containing the. It is a block diagram of 2nd Embodiment of the submucosa peeling treatment tool system and submucosa peeling treatment tool set which concern on this invention. It is a side view of the auxiliary device which is a component of the submucosal layer peeling treatment tool set shown in FIG. FIG. 28 is a top view of an auxiliary device which is a component of the submucosal layer peeling treatment tool set shown in FIG. 27. FIG. 29 is a cross-sectional arrow view DD shown in FIG. 28. FIG. 28 is a side view of an auxiliary device that is a component of the submucosal layer peeling treatment tool set shown in FIG. 27, and shows a state where a pair of forceps pieces are open. It is a block diagram of the submucosa peeling treatment tool which is a component of the submucosa peeling treatment tool set shown in FIG. It is a cross-sectional arrow EE figure shown in FIG. It is a figure which shows the state which protruded the insertion part main body of the auxiliary device from the front-end | tip of the treatment tool main body of a submucosa peeling treatment tool, Comprising: (a) is a side view, (b) is the insertion part in the state of (a) It is a figure which shows sectional drawing of a main body. It is a figure which shows the process of the submucosa peeling method which excises a lesioned part by the submucosa peeling treatment instrument system and the submucosal peeling treatment tool set shown in FIG. 27, Comprising: The front-end | tip of the insertion part main body of an auxiliary device is inserted in an insertion hole. FIG. It is a figure which shows the process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment instrument system and the submucosal layer peeling treatment tool set shown in FIG. 27, Comprising: After the state shown in FIG. It is a figure which shows the state which made it insert in and was made to contact a proper muscle layer, received the repulsive force from this proper muscle layer, and was curved upwards. It is a figure which shows one process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment instrument system and submucosal layer peeling treatment tool set shown in FIG. 27, Comprising: An insertion part main body is inserted in a submucosal layer from an insertion hole. It is a figure which shows the state inserted in opening and closing a pair of forceps pieces in the case. It is a figure which shows one process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and the submucosal layer peeling treatment tool set shown in FIG. 27, and after penetrating the insertion route by the insertion portion main body, It is a figure which shows the state which has hold | gripped the mucous membrane lowermost layer of the insertion route with the forceps piece. It is a figure which shows one process of the submucosal layer peeling method which excises a lesioned part by the submucosal layer peeling treatment tool system and the submucosal peeling treatment tool set shown in FIG. 27, Comprising: After a state shown in FIG. It is a figure which shows the state which has pushed the treatment tool main body into the insertion route, holding the submucosa.

Explanation of symbols

W Submucosal layer X Lesions R Insertion route H Insertion hole 1, 60 Submucosal layer peeling treatment instrument system 2, 63 Submucosal layer peeling treatment tool set 3 Treatment tool channel (channel)
4 Insertion Section 5 Endoscope 6 Submucosal Injection Needle 7, 62 Auxiliary Device 8, 61 Peeling Balloon (Submucosal Peeling Treatment Tool)
10, 70 Insertion section body 11 Bending pipe line (pipe line)
12 Operation wire (wire)
13 Operation part 14 Plate member (Bending auxiliary member)
16 Tip 18 Multiple communication holes (flexible part)
20 Indicator part 25 Treatment tool body 26 Fluid conduit 27 Balloon (inflatable part)
71 Flexible part 72 Pair of forceps pieces 73 Forceps piece operation part

Claims (13)

A submucosal dissection treatment tool set that locally exfoliates the submucosa and excises the lesion of the digestive tract,
A flexible insertion portion main body, a conduit formed from the proximal end side to the distal end side of the insertion portion main body, a wire inserted into the conduit with the distal end side fixed, and the wire of which is fixed to the base end side, a manipulation unit for curving in a predetermined direction insertion portion main body the insertion portion and the pressing wire pulling operation to relative to the body of the insertion portion main body in the distal end side of the insertion portion main body A flexible portion that is provided only on one side in the predetermined direction with respect to the shaft core and has more flexibility than the other portion, and the wire is disposed on the one side with respect to the shaft core and has a predetermined size on the submucosal layer. An auxiliary device that penetrates the insertion route;
A flexible treatment instrument body inserted into the submucosa along the insertion route, a fluid conduit formed from the proximal end side to the distal end side of the treatment instrument body, and the treatment instrument A submucosal layer exfoliation treatment instrument set, comprising: a submucosal layer exfoliation instrument that is provided on the distal end side of the main body and expands when the fluid is supplied through the fluid conduit . In the submucosal layer peeling treatment tool set according to claim 1,
The submucosal layer peeling treatment instrument set, wherein the flexible portion is a communication hole that is formed in the insertion portion main body and communicates the duct and the outside. In the submucosal layer peeling treatment instrument set according to claim 1 or 2,
The auxiliary device includes a bending auxiliary member having a cross-sectional characteristic that is curved in a predetermined direction at least on the distal end side of the insertion portion main body, and the constant direction and the bending direction are the same direction. A submucosal detachment treatment tool set characterized by that. In the submucosal layer peeling treatment tool set according to claim 3,
The submucosal layer peeling treatment instrument set, wherein the bending auxiliary member is formed in a plate shape, and the thickness direction of the bending auxiliary member is the constant direction. In the submucosal layer exfoliation treatment instrument set according to any one of claims 1 to 4 ,
The submucosal layer peeling treatment instrument set, wherein the auxiliary device includes a spherical tip at the tip of the insertion portion main body. In the submucosal detachment treatment instrument set according to any one of claims 1 to 5 ,
The auxiliary device includes a submucosal layer peeling treatment instrument set, wherein the treatment instrument main body includes an index portion indicating an amount of insertion into the submucosa. A submucosal dissection treatment tool set that locally exfoliates the submucosa and excises the lesion of the digestive tract,
A flexible insertion portion main body, a conduit formed from the proximal end side to the distal end side of the insertion portion main body, a wire inserted into the conduit with the distal end side fixed, and the wire of which is fixed to the base end side, a manipulation unit for curving in a predetermined direction insertion portion main body the insertion portion and the pressing wire pulling operation to relative to the body of the insertion portion main body in the distal end side of the insertion portion main body A flexible portion that is provided only on one side in the predetermined direction with respect to the shaft core and has more flexibility than the other portion, and the wire is disposed on the one side with respect to the shaft core and has a predetermined size on the submucosal layer. An auxiliary device that penetrates the insertion route;
A flexible treatment instrument body inserted into the submucosa along the insertion route, a fluid conduit formed from the proximal end side to the distal end side of the treatment instrument body, and the treatment instrument An inflatable portion that is provided on the distal end side of the main body and expands when supplied with fluid via the fluid conduit; and from the proximal end side to the distal end side of the treatment instrument main body along the fluid conduit A submucosal layer exfoliation treatment tool that is formed over and includes an insertion conduit that passes through the insertion portion main body,
The length of the insertion part main body is longer than the length of the insertion duct, The submucosal layer peeling treatment tool set, In the submucosal layer peeling treatment tool set according to claim 7 ,
The auxiliary device includes a bending auxiliary member having a cross-sectional characteristic that is curved in a predetermined direction at least on the distal end side of the insertion portion main body, and the constant direction and the bending direction are the same direction. A submucosal detachment treatment tool set characterized by that. In the submucosal detachment treatment tool set according to claim 7 or 8 ,
The submucosal layer peeling treatment instrument set, wherein the auxiliary device includes a spherical tip at the tip of the insertion portion main body. In the submucosal detachment treatment tool set according to any one of claims 7 to 9 ,
The auxiliary device includes a submucosal layer peeling treatment instrument set, wherein the treatment instrument main body includes an index portion indicating an amount of insertion into the submucosa. A submucosal layer peeling treatment instrument set according to any one of claims 7 to 10 ,
An endoscope having a channel through which the treatment instrument body is inserted, and a submucosal layer separation treatment instrument system. The submucosal layer peeling treatment device system according to claim 11 ,
The endoscope includes a second channel;
A submucosal detachment treatment instrument system comprising a submucosal local injection needle that is inserted into the second channel and injects a liquid into the submucosa. The submucosal layer peeling treatment device system according to claim 11 ,
The endoscope includes a second channel;
A submucosal detachment treatment instrument system comprising grasping forceps inserted through the second channel and grasping the lesioned part.

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