JP5288101B2 - Endoscopic injection tool and surgical kit for endoscopic resection - Google Patents

Description

  The present invention relates to an endoscope injection tool and a surgical kit for endoscopic resection.

  Conventionally, a lesion site of early gastric cancer has been excised using an endoscope that inserts an insertion sheath into the stomach. In this early gastric cancer resection, in addition to EMR, endoscopic submucosal dissection is performed in which the lesioned mucosa is removed using a high-frequency knife (IT knife, flex knife, hook knife, etc.) in order to remove a large lesion. (Endoscopic Submucosal Dissection (ESD)) has become widespread. In ESD, since the gastric wall perforation rate at which a hole is opened in the stomach by endoscopic surgery is as high as 4%, it is an issue to safely remove the lesion. For this reason, when excising a lesion such as early gastric cancer, physiological saline is injected between the submucosal layer and the muscle layer to raise the lesion, and the submucosal layer is incised and detached using a snare or a high-frequency knife. I went.

  A typical conventional excision method for a lesion such as early gastric cancer will be described with reference to FIGS. 14 (a) to 14 (d) are perspective views showing a conventional operation during excision of a lesion, FIG. 15 is a cross-sectional view taken along the line AA in FIG. 14 (b), and FIG. It is BB sectional drawing of (c).

  In the conventional method, first, as shown in FIG. 14 (a), markings 52 are made at several places around the lesioned part 51 under the endoscope, and then, as shown in FIGS. 14 (b) and 15, Aiming at this marking 52 point, an appropriate amount of physiological saline 55 is injected between the mucosa layer 53 and the muscle layer 54 to raise the lesioned part 51. Thereafter, as shown in FIG. 14C and FIG. 16, the periphery of the lesioned part 51 is incised using an IT knife 56, and if necessary, the lesioned part 51 is separated with another high-frequency knife, hook knife or the like (not shown). The muscle layer 54 is peeled off. And as shown in FIG.14 (d), the excised lesion part 51 is captured using a collection | recovery net | network, a tripod, and a pentapod, The endoscope is extracted and the lesion part 51 is collect | recovered. In this case, treatment is performed by mutually replacing and inserting endoscope treatment tools such as a physiological saline injection tool, an IT knife, and a snare from one treatment tool guide channel of an endoscope (not shown).

  However, when the lesion is raised by locally injecting physiological saline as described above, the injected physiological saline diffuses into the submucosal layer over time, so that the artificially formed mucosal elevation gradually Go flat. Sufficient bulging of the lesion is necessary for incision and detachment of the lesion, and if the bulge of the lesion is not sufficient, the possibility of perforation of the muscle layer increases. Therefore, when excising the lesion, when the locally injected physiological saline diffuses and the mucosal bulge becomes flat, the saline is injected again locally, or hyaluronic acid with high water retention capacity is injected locally. It is also known to increase the distance between adjacent muscle layers or normal tissues using other means in combination.

  For example, Patent Document 1 below discloses an invention of a magnetic anchor guiding device that lifts a lesion by combining a magnetic anchor and a clip in order to make the lesion easily peelable. Therefore, a magnetic anchor guiding device disclosed in the following Patent Document 1 will be described below with reference to FIG. FIG. 17 is a view showing a use situation of the magnetic anchor guiding device in the stomach.

  The magnetic anchor guiding device 60 includes a clip 62 attached to a lesioned part 61, a magnetic anchor 64 attached to the clip 62 via a connecting part 63, and a magnetic force that applies a driving force to the magnetic anchor 64 from the outside. And a derivative 65. The magnetic anchor guide device 60 lifts the lesioned part 61 by the following operation. First, similarly to the conventional method, the lesioned part 61 is raised by injecting physiological saline 67 into the lower part of the lesioned part 61 using the endoscope 66. Next, the clip 62 is attached to the lesioned part 61 with the grasping forceps 68. Next, the endoscope 66 is pulled out, the magnetic anchor 64 is attached to the grasping forceps 68, the endoscope 66 is inserted again, and the external magnetic derivative 65 is operated to fix the magnetic anchor 64 at a predetermined position of the affected part.

  Thereafter, the endoscope 66 is pulled out, the connecting portion 63 is attached to the grasping forceps 68, the endoscope 66 is inserted again, one end of the connecting portion 63 is attached to the clip 62 in the affected area, and the other end of the connecting portion 63 is magnetically connected. Attach to the anchor 64. In this state, the lesioned part 61 can be lifted by operating the magnetic derivative 65 from the outside and pulling the clip 62. In this state, the lesioned part can be safely excised with an IT knife or the like. .

  However, the magnetic anchor guiding device 60 disclosed in the above-mentioned Patent Document 1 attaches the clip 62 to the lesion 61, attaches the clip 62 and the magnetic anchor 64, and operates the external magnetic derivative 65 to operate the magnetic anchor 64. Multistage operations such as fixing the affected area at a predetermined position and lifting the lesioned part by operating the external magnetic derivative 65 are necessary, and the size of the magnetic anchor 64 is large. The endoscope 66 needs to be inserted and removed, and the external magnetic derivative 65 cannot be operated by a person who operates the magnetic anchor guiding device 60. Therefore, another person needs to operate it. There is a problem that the operation is complicated and time-consuming, and it is not widely used at present.

  On the other hand, in Patent Document 2 below, as shown in FIG. 18, a guide sheath 73 having one endoscope channel 71 and two treatment instrument guide insertion instrument channels 72 is used, and two treatments are performed. The lesioned part is lifted by two forceps 74 and 75 inserted from the tool guide insertion tool channel 72, respectively, and the electric knife 77 passed through the endoscope 76 inserted from one endoscope channel 71. An endoscopic treatment device 70 for excising a lesion is disclosed.

  However, the endoscope treatment apparatus 70 disclosed in Patent Document 2 is configured to lift the lesioned portion with the two forceps 74 and 75 inserted from the two treatment tool guide insertion tool channels 72, respectively. However, in such a configuration, since the outer diameter of the guide sheath 73 is increased by the number of treatment tool guide insertion tool channels, there is a problem that patient pain increases.

  Furthermore, in the magnetic anchor guidance device 60 disclosed in Patent Document 1 and the endoscope treatment apparatus 70 disclosed in Patent Document 2, there is a problem that a lesion may remain around the lesion mucosa. Yes.

  Therefore, one of the inventors of the present application has been researching and developing after obtaining an endoscopic treatment instrument that can solve the problems of the conventional examples as described above, and has already been published as Patent Document 3. Technology has been developed. Patent Document 3 discloses a technique that allows a cancer mucosa to be freely operated and raised by pulling three clips and a thread by hand. In Patent Document 3, the endoscope can be inserted into the body cavity once, and the entire lesion can be reliably lifted, and can be easily excised without leaving the lesion. It is described that a simple endoscopic treatment tool can be obtained.

JP 2004-105247 A JP 2000-325303 A JP 2007-143869 A

  As described above, by using the endoscope treatment tool described in Patent Document 3 developed by one of the present inventors, the insertion of the endoscope into the body cavity is certainly only once. In addition, the entire lesion can be reliably lifted and can be easily excised without leaving the lesion. That is, since the technique described in Patent Document 3 embodies the concept of “Fool Proof” which is a kind of safety idea, the operator's field of view and work area are widened, and the high frequency knife is mistaken in the first place. It has become possible to reduce the possibility of making mistakes that cut too deeply into the stomach wall.

  However, since ESD is still technically difficult, in the case of an unskilled operator who is not highly skilled in ESD, even if the endoscopic treatment instrument described in Patent Document 3 is used, a high-frequency knife is used. It is difficult to completely avoid mistakes that are deeply cut into the stomach wall and the like, and the problem of causing gastric wall perforation that opens a hole in the stomach by endoscopic surgery has not been completely overcome.

  In view of such a situation, one of the inventors of the present application is actually an unskilled surgeon who is not highly skilled in ESD based on the concept of Fail Safe, which is a kind of safety idea. Even if he made a mistake, he realized that it was necessary to develop a technique capable of reducing the possibility of causing gastric wall perforation to open a hole in the stomach by endoscopic surgery, and started research and development of the present invention.

  The present invention has been made in view of the above circumstances, and even if an unskilled operator who is not highly skilled in ESD mistakenly makes a mistake of cutting a high-frequency knife or the like too deeply into the stomach wall or the like, an endoscope is provided. An object of the present invention is to provide a safe technique that can reduce the possibility of gastric wall perforation that opens a hole in the stomach by surgery.

  According to the present invention, there is provided an injection device for an endoscope, an outer tube formed of a flexible tube, an extraction portion provided so as to be partially protruded from a distal end portion of the outer tube, and an inner tube Arranged along the tube axis direction of the liquid feeding tube, and the connection port between the liquid feeding tube communicating with the dispensing portion and the syringe main body provided at the rear end of the liquid feeding tube. There is provided an endoscope injection tool including an electric heating material and an electric connector provided at a rear end portion of the electric heating material.

  According to this endoscope injection tool, since the electric heating material is disposed along the tube axis direction of the liquid feeding tube, the liquid feeding tube can be heated. Therefore, it is possible to smoothly feed a biocompatible insulating material having low fluidity at room temperature and difficult to smoothly feed inside the liquid feeding tube in the liquid feeding tube. . Therefore, by using this endoscope injection tool in combination with an endoscope, it becomes possible to smoothly feed a biocompatible insulating material into the digestive organs.

  Therefore, even for an unskilled surgeon who is not highly skilled in ESD, this endoscopic injection tool is used in combination with an endoscope and has biocompatibility between the submucosa and the muscle layer in advance. By injecting the insulating material, it is possible to previously form a protective sheet for preventing perforation between the submucosa and the muscle layer. Therefore, by using this endoscope injection tool in combination with an endoscope, it is assumed that an unskilled operator who is not highly skilled in ESD mistakenly made a mistake that cut a high-frequency knife or the like too deeply into the stomach wall or the like. However, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased.

  Moreover, according to the present invention, there is provided a surgical kit for endoscopic resection, comprising the above-described endoscope injection tool and a biocompatible insulating material. .

  According to this surgical kit, since the endoscope injection tool and the biocompatible insulating material are provided as a set, it is assumed that the surgeon is an unskilled surgeon who is not highly skilled in ESD. However, this endoscope injection tool is used in combination with an endoscope, and by injecting a biocompatible insulating material between the submucosa and muscle layers in advance, a protective sheet that prevents so-called perforation. Can be formed in advance between the submucosa and muscle layers. Therefore, by using this endoscope injection tool in combination with an endoscope, it is assumed that an unskilled operator who is not highly skilled in ESD mistakenly made a mistake that cut a high-frequency knife or the like too deeply into the stomach wall or the like. However, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased.

  In addition, according to this surgical kit, it is possible to adjust detailed conditions in advance when shipping the above-described endoscope injection tool and the biocompatible insulating material. Therefore, it is possible to eliminate the necessity of reconciling the detailed conditions on the user side, and even if an unskilled surgeon who is not highly skilled in ESD, the biocompatibility between the submucosal layer and the muscular layer is set in advance. It becomes easy to inject the insulating material. Furthermore, according to this operation kit, since it is possible to omit the necessity of reconciling detailed conditions on the user side, labor costs and the like when performing ESD can be saved, and medical costs can be suppressed.

  According to the present invention, a protective sheet that prevents perforation is formed between the submucosa and the muscle layer in advance by injecting a biocompatible insulating material between the submucosa and the muscle layer in advance. It becomes possible. Therefore, even if an unskilled surgeon who is not highly skilled in ESD mistakenly makes a mistake of cutting a high-frequency knife or the like too deeply into the stomach wall or the like, the possibility of gastric wall perforation that opens a hole in the stomach can be reduced.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In all the drawings, the same reference numerals are given to the same components, and the description will be omitted as appropriate.

<Embodiment 1: Endoscopic injection tool>
The endoscope injection tool according to this embodiment is an endoscope used for endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and the like. It is a kind of treatment tool, especially when excision of lesions such as early gastric cancer, the lesion is raised so that the lower layer of the lesion is easily peeled off, and biocompatibility between the submucosa and the muscle layer in advance It is an endoscope injection tool for forming a protective sheet for preventing perforation between the submucosa and the muscular layer in advance by injecting an insulating material having the above.

  FIG. 1 is a configuration diagram for explaining the overall configuration of the endoscope injection tool of the present embodiment. The endoscope injection tool 100 basically has the same configuration as a commercially available general endoscope injection tool. That is, the endoscope injection tool 100 includes an outer tube 105 having a length of 1650 mm formed by a flexible tube. The endoscope injection device 100 includes an extraction portion 101 that is provided so as to partially protrude from the distal end portion of the outer tube 105. Further, the endoscope injection device 100 includes a liquid feeding tube (not shown) provided in the outer tube 105 and communicating with the extraction unit 101. The endoscope injection tool 100 includes a connection port 108 with a syringe body provided at a rear end portion of a liquid feeding tube (not shown).

  As described above, the endoscope injection tool 100 has a configuration similar to that of a commercially available general endoscope injection tool, and a syringe is attached to the connection port 108 at the time of use so that the blood vessel or the submucosa It is now possible to inject various drugs. Further, various chemicals used at the time of use are sent from the connection port 108 to the dispensing unit 101 at the distal end through a liquid feeding tube (not shown). Then, the drug is poured out from the dispensing unit 101 toward the blood vessel or the mucous membrane.

  Further, the endoscope injection tool 100 includes a slider 109 as shown in the figure. When the slider 109 is moved back and forth, the extraction portion 101 is protruded or stored at the distal end portion of the outer tube 105. The endoscope injection device 100 also includes a grip 102, and the color at the tip of the grip portion 102 indicates the minimum channel diameter of the applicable endoscope. To the endoscope main body (not shown). It has been devised to facilitate the application of. Although not shown, the endoscope injection tool 100 is displayed with a product symbol, and the diameter of the extraction portion 101 and the protruding length of the extraction portion 101 from the outer tube 105 (example 23G × 4mm) is displayed, which is convenient for the surgeon.

  Moreover, the injection | pouring part 101 of the injection tool 100 for endoscopes uses the normal injection needle. Here, a 23G injection needle is used, and the tip is sharp. By using a needle with a sharp tip like this, even when the gap between the submucosa and the muscle layer is narrow, a biocompatible insulating material can be injected well, which is so-called protection that prevents perforation. A sheet can be formed in advance between the submucosa and muscle layers.

  Further, the dispensing portion 101 of the endoscope injection tool 100 is provided so as to be able to enter and exit from the distal end portion of the outer tube 105, and the liquid feeding tube 121 is provided so as to be able to advance and retract within the outer tube 105. Since such a configuration is adopted, when the operator moves the grip connected to the rear end of the liquid feeding tube 121 back and forth with his / her own hand, the liquid feeding tube 121 itself freely moves back and forth. . As a result, the pouring portion 101 can freely enter and exit from the distal end portion of the outer tube 105. Therefore, even when a normal injection needle is used as the dispensing portion 101, when the endoscope injection tool 100 is inserted into the digestive organ, the tip of the injection needle is retracted into the outer tube 105 and digested. It can be protected from damaging the organs. When the endoscope injection tool 100 is inserted into the digestive organ and positioning is completed, the tip of the injection needle protrudes outside the mantle tube 105, and the gap between the submucosal layer and the muscle layer is successfully achieved. An insulating material having biocompatibility can be injected, so that it is possible to previously form a protective sheet for preventing perforation between the submucosa and the muscle layer.

  However, the endoscope injection tool 100 according to the present embodiment also has a configuration different from the commercially available general endoscope injection tool as described below. For example, the endoscope injection device 100 includes a heating wire 110 (electric heating material) arranged along the tube axis direction of a liquid feeding tube (not shown), and adds a liquid feeding tube (not shown). Can be warmed. The endoscope injection device 100 also includes an electrical connector (not shown) provided at the rear end of the heating wire 110 (electric heating material). The electrical connector (not shown) and the lead wire 111 are connected to the endoscope injection tool 100. The heating wire 110 (electric heating material) and the heating power source 112 are electrically connected to each other.

  FIG. 2 is an enlarged conceptual view of the internal structure of the distal end portion of the endoscope injection tool 100 according to the present embodiment. As described above, the heating wire 110 (electric heating material) provided for heating the liquid feeding tube 121 having the maximum outer diameter of 2.5 mm of the endoscope injection device 100 includes at least one set as illustrated. The heating wire 110 is composed of a forward path and a return path that are electrically connected to each other.

  As shown in the figure, the forward path of the heating wire 110 is provided in the gap between the outer tube 105 and the liquid feeding tube 121, and is wound spirally around the liquid feeding tube 121. On the other hand, the return path of the heating wire 110 is linearly provided inside the liquid feeding tube 121. Since the forward path and the return path of the heating wire 110 must be electrically connected to each other, a hole 166 having a diameter of about 0.3 mm is formed on the side surface near the tip of the liquid feeding tube 121, and the inside of the hole 166 is a conductor. By passing, the forward path and the return path of the heating wire 110 are electrically connected to each other. In addition, the gap after passing the heating wire 110 of this hole 166 is provided with a weathering so that the contents in the liquid supply tube do not leak through the hole 166.

The heating wire 110 has an electrical resistivity of 1.0 × 10 ⁻⁷ Ω · m to 1.6 × 10 ⁻⁶ Ω · m and a cross-sectional area of 7.85 × 10 ⁻³ mm ^{2 to} 1.25 ×. It is a heating wire of 10 ⁻¹ mm ² or less. Thus, the electrical resistivity is 1.0 × 10 ⁻⁷ Ω · m or more and 1.6 × 10 ⁻⁶ Ω · m or less, and the cross-sectional area is 7.85 × 10 ⁻³ mm ² or more and 1.25 × 10 ⁻¹ mm. By using the heating wire 110 of ² or less, the liquid supply tube 121 is used even when the heating power source 112 in the range of a normal voltage of 10 V or more and 500 V or less is used in combination with other conditions for the spiral shape described later. Can be adjusted to a range of 40 ° C. or higher and 95 ° C. or lower.

  Further, the heating wire 110 is provided in the spiral region so that the spiral diameter is 1.0 mm or more and 5.0 mm or less and the spiral interval is 5 mm or more and 20 mm or less. Thus, by using the heating wire 110 provided so that the spiral diameter is 1.0 mm or more and 5.0 mm or less and the spiral interval is 5 mm or more and 20 mm or less in the spiral region, the material and shape of the heating wire described above are used. In combination with other conditions, the temperature of the liquid feeding tube can be adjusted to a range of 40 ° C. or more and 95 ° C. or less even when a power source having a normal voltage of 10 V or more and 500 V or less is used.

  And if it is such a heating wire 110, since the temperature of a liquid feeding tube can be adjusted in the range of 40 degreeC or more and 95 degrees C or less, generally the fluidity | liquidity is low in normal temperature, and the inside of the liquid feeding tube 121 is smooth. It is possible to smoothly feed the insulating material having biocompatibility that is difficult to feed in the liquid feeding tube 121. Therefore, by using this endoscope injection tool together with an endoscope (not shown), it becomes possible to smoothly feed the biocompatible insulating material into the digestive organs.

  Such an insulating material having biocompatibility is not particularly limited. For example, animal-derived natural fats and oils, plant-derived natural fats and oils, agar, silicon, polymethyl methacrylate, rubber, cyanoacrylate, chitosan One or more materials selected from the group consisting of can be suitably used. For these materials as well, many of them can be obtained by adjusting the temperature of the liquid feeding tube to a range of 40 ° C. or higher and 95 ° C. or lower, so that sufficient fluidity can be obtained and liquid can be smoothly fed in the liquid feeding tube 121. Is possible.

  Even if the temperature of the liquid feeding tube 121 is adjusted to a range of 40 ° C. or higher and 95 ° C. or lower, the fluidity is low and even when it is difficult to smoothly feed the liquid feeding tube 121, the above In the case of the heating wire 110 configured as described above, the temperature of the liquid feeding tube 121 is set to 95 by further amplifying the voltage to an appropriate voltage exceeding 50 V, 100 V, or 500 V using a known general transformer. It can be heated to a suitable temperature in excess of ° C. As a result, the temperature of the contents of the liquid feeding tube 121 can be adjusted to be equal to or higher than the glass transition point of the contents, so that sufficient fluidity can be obtained and the liquid feeding tube 121 can be smoothly fed. Is possible.

Or if the said phenomenon is demonstrated from another viewpoint, even if it adjusts the temperature of the liquid feeding tube 121 to the range of 40 degreeC or more and 95 degrees C or less, fluidity | liquidity is low and it will feed the inside of the liquid feeding tube 121 smoothly. Even if it is difficult, if the heating wire 110 is configured as described above, the voltage is further amplified to an appropriate voltage exceeding 50V, 100V or 500V using a known general transformer. Thus, the temperature of the liquid feeding tube 121 can be heated to an appropriate temperature exceeding 95 ° C. As a result, the viscosity of the contents of the liquid feeding tube 121 is equal to or lower than a predetermined viscosity (for example, a viscosity of 1 × 10 ⁻¹ Pa · s or less, 1 × 10 ⁻² Pa · s or less, or 1 × 10 ⁻³ Pa · s. Therefore, sufficient fluidity can be obtained, and the liquid can be smoothly fed in the liquid feeding tube 121.

  Furthermore, if the above phenomenon is explained from another viewpoint, even if the temperature of the liquid feeding tube 121 is adjusted to a range of 40 ° C. or higher and 95 ° C. or lower, the fluidity is low and the liquid feeding tube 121 is smoothly fed. Even if it is difficult, if the heating wire 110 is configured as described above, the voltage is further amplified to an appropriate voltage exceeding 50V, 100V or 500V using a known general transformer. Thus, the temperature of the liquid feeding tube 121 can be heated to an appropriate temperature exceeding 95 ° C. As a result, the melt flow rate of the contents of the liquid feeding tube 121 is equal to or higher than a predetermined threshold (for example, the melt flow rate is preferably 1 g / 10 min or higher, 10 g / 10 min or higher, or 100 g / 10 min or higher). Since it can be adjusted, sufficient fluidity is obtained, and the liquid can be smoothly fed in the liquid feeding tube 121.

  Here, the melt flow rate (MFR) is an opening provided at the bottom of the container by heating and pressurizing a certain amount of resin or the like in a cylindrical container heated by a heater at a predetermined temperature. It is calculated by measuring the amount of resin extruded from the (nozzle) per 10 minutes. The value is displayed in the unit of g / 10 min. The test machine uses an extrusion plastometer defined by JIS K6760, and the measuring method is defined by JIS K7210. As a similar measuring instrument, there are a Koka type flow tester, a lossy peak flow tester, etc., and in principle there is a slight difference in the measuring method, but in principle the fluidity is measured by the discharge amount of resin or the like.

Hereinafter, the effect of the injection tool 100 for endoscopes of this embodiment is demonstrated.
According to the endoscope injection device 100, since the heating wire 110 is disposed along the tube axis direction of the liquid feeding tube 121, the liquid feeding tube 121 can be heated. Therefore, in general, it is possible to smoothly feed the biocompatible insulating material having low fluidity at room temperature and difficult to smoothly feed the liquid feeding tube 121 in the liquid feeding tube 121. It is. Therefore, by using this endoscope injection tool 100 together with an endoscope (not shown), it becomes possible to smoothly feed a biocompatible insulating material into the digestive organs.

  Therefore, even for an unskilled operator who is not highly skilled in ESD, this endoscopic injection device 100 is used in combination with an endoscope (not shown), and is previously placed between the submucosa and the muscle layer. By injecting an insulating material having biocompatibility, it is possible to previously form a protective sheet for preventing perforation between the submucosa and the muscle layer. Therefore, by using this endoscope injection tool 100 in combination with an endoscope (not shown), an unskilled operator who is not highly skilled in ESD accidentally cuts a high-frequency knife or the like too deeply into the stomach wall or the like. Even if a mistake is made, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased.

<Embodiment 2: Modification using sensor>
The endoscope injection tool 100 according to the present embodiment has basically the same configuration as the endoscope injection tool 100 according to the first embodiment, but measures the temperature of the liquid feeding tube 121. The difference is that a temperature sensor (not shown) is further provided. Such a temperature sensor (not shown) can be provided, for example, in the gap between the outer sheath portion 105 at the distal end portion of the endoscope injection device 100 shown in FIG. By providing in such a position, it becomes possible to measure the temperature of the liquid feeding tube 121 suitably.

  Note that only one temperature sensor (not shown) may be provided, but two or more temperature sensors may be provided. In that case, not only in the gap between the distal end portion of the endoscope injection tool 100 shown in FIG. 2 and the liquid feeding tube 121, but also in the intermediate portion of the endoscope injection tool 100. It is also preferable to provide it in the gap between the liquid feeding tubes 121. Furthermore, if possible, it is also preferable to provide it in the gap between the outer sheath portion 105 at the rear end portion of the endoscope injection device 100 and the liquid feeding tube 121. Further, when a biocompatible insulating material placed in a certain container is injected from the connection port at the rear end of the liquid feeding tube 121, the temperature of the container (not shown) can be further measured. Two temperature sensors (not shown) may be provided.

  In any case, the temperature of the liquid feeding tube 121 or the container (not shown) is determined based on the measurement data of the temperature of the liquid feeding tube 121 or the container obtained from one or more temperature sensors (not shown). The value of the current or voltage input from the electrical connector (not shown) to the heating wire 110 is fed back from the heating power supply 112 via the lead wire 111 so that the temperature is within a predetermined temperature range (for example, 40 ° C. or more and 95 ° C. or less). It is preferable to further include a feedback control unit (not shown) for controlling.

  By adopting such a configuration, the temperature of the liquid feeding tube 121 or the container (not shown) can be controlled to be within a predetermined temperature range (for example, 40 ° C. or more and 95 ° C. or less). Then, it is possible to feed the insulating material having biocompatibility, which has low fluidity and is difficult to smoothly feed in the liquid feeding tube 121, more stably and smoothly in the liquid feeding tube 121. is there. Therefore, by using this endoscope injection tool in combination with an endoscope (not shown), it becomes possible to smoothly and stably deliver a biocompatible insulating material into the digestive organs.

  In addition, although it does not specifically limit as said temperature sensor (not shown), For example, a platinum resistance thermometer can be used. In addition, a thermistor, a thermocouple, an IC temperature sensor, or the like can be used. Here, the platinum resistance temperature detector uses the property that the electric resistance of the metal changes with respect to the temperature change. Needless to say, other than platinum, a metal such as gold, copper, or iron may be used. it can.

<Embodiment 3: Modification using a double lumen>
The endoscope injection tool 100 according to the present embodiment has basically the same configuration as the endoscope injection tool 100 according to the first and second embodiments described above, but the liquid feeding tube 121 is provided. The dispensing portion 101 has two or more outlets (not shown) that respectively communicate with the two or more lumens (not shown). Thus, by having two or more lumens (not shown), two types of materials (for example, white insulating materials) having different contents of pigments that absorb a laser beam having a predetermined wavelength are used as biocompatible materials. And a green conductive material) can be made into two layers, and a biocompatible material can be injected between the submucosa and the muscle layer.

  At this time, it is preferable that two or more spouts (not shown) of the pouring part 101 are two or more flat spouts (not shown) which are parallel to each other. This is because it is easy to inject a material having biocompatibility between the submucosal layer and the muscular layer by using two kinds of materials having different colors and electrical conductivity by using such an extraction unit 101. Because it becomes. Moreover, it is preferable that two or more lumens (not shown) or two or more extraction ports (not shown) are provided with colors, symbols, figures, or shapes that can be distinguished from one another with the naked eye.

  In this way, the endoscope is used in combination with two or more lumens (not shown) of the liquid delivery tube 121 while visually checking two or more outlets (not shown) of the outlet 101 (upward and downward). It becomes easy to position well so that the positions of two or more lumens (not shown) or two or more extraction ports (not shown) to be reversed do not reverse. For example, green color is applied to an upper lumen (not shown) or an extraction port (not shown) from which green material is to be poured out, and a lower lumen (not shown) or extraction from which white material is to be poured out. It is preferable to apply a white color to the mouth (not shown) because proper positioning can be performed by an intuitive operation.

  Here, in the case of two layers, the insulating material of the lower layer is preferably a material close to white with a small content of a dye that absorbs a laser beam having a predetermined wavelength. On the other hand, the current-carrying material in the upper layer is preferably a colored material having a large content of a dye that absorbs a laser beam having a predetermined wavelength (for example, green). In this way, even an inexperienced operator who is not highly skilled in ESD can use the endoscope injection tool 100 in combination with an endoscope (not shown) as a lower layer of the stomach. Two types of injection material, white injection material to prevent perforation and colored injection material to be injected for excision as an upper layer, can be locally injected submucosally. A laser absorbing sheet can be formed in advance between the submucosa layer and the muscle layer.

  Therefore, by using a laser light source having a predetermined wavelength (for example, a green wavelength) and a laser probe for an endoscope that can be connected to the laser light source in combination, the lower white sheet is Although the laser energy is not absorbed, the upper diagno green layer is excited by the laser energy. In other words, it becomes possible to perform laser treatment that can recover a cancer excision by local injection of two substances, so that an unskilled surgeon who does not have a high level of ESD skill mistakenly mistakenly irradiates the stomach wall too strongly. Even so, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased.

<Embodiment 4: Surgery kit for endoscopic resection>
The surgical kit for endoscopic resection according to the present embodiment is a surgical kit including any one of the above-described endoscope injection tools 100 and a biocompatible material. Here, the material having biocompatibility is not particularly limited, and examples thereof include animal-derived natural fats and oils, plant-derived natural fats and oils, agar, silicon, polymethyl methacrylate, rubber, cyanoacrylate, and chitosan. One or more materials selected from the group consisting of:

  According to such a surgical kit, since the endoscope injection tool 100 and the biocompatible material are provided as a set, an unskilled operator who is not highly skilled in ESD. Even so, by using this endoscope injection tool 100 in combination with an endoscope (not shown), by injecting a biocompatible material between the submucosa and the muscle layer in advance, In other words, a protective sheet for preventing perforation can be formed in advance between the submucosa and the muscle layer. Therefore, by using this endoscope injection tool 100 in combination with an endoscope (not shown), an unskilled operator who is not highly skilled in ESD accidentally cuts a high-frequency knife or the like too deeply into the stomach wall or the like. Even if a mistake is made, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased.

  Further, according to such a surgical kit, it is possible to adjust detailed conditions in advance when shipping the above-described endoscope injection tool 100 and a biocompatible material. Therefore, it is possible to omit the necessity of sliding the temperature at which the fluidity of the material having biocompatibility is sufficiently increased on the user side and the condition for adjusting the temperature of the liquid feeding tube 121 to the temperature. Even an immature surgeon who is not highly skilled can easily inject a biocompatible material between the submucosa and the muscle layer in advance. Furthermore, according to this surgical kit, the necessity for sliding the temperature for sufficiently increasing the fluidity of the biocompatible material on the user side and the condition for adjusting the temperature of the liquid feeding tube 121 to that temperature is omitted. Therefore, it is possible to save labor costs when performing ESD, and to contribute to medical cost control.

  Here, when the endoscope injection device 100 has the double lumen structure described in the third embodiment, the biocompatible material is a laser beam having a predetermined wavelength (for example, a green wavelength). It is preferable to include one type of insulating material and one type of current-carrying material, or two types of insulating materials, which are different in the content and conductivity of the dye that absorbs water. At this time, the surgical kit further includes a laser light source having a predetermined wavelength (for example, a green wavelength) and an endoscope laser probe 172 connectable to the laser light source. Even more preferred.

  The laser light source is not particularly limited. For example, as a laser light source that can be suitably applied to an endoscope, (1) holmium yag laser: it can oscillate in water as an advantage, (2 ) KTP laser: easy to absorb green, (3) neodymium yag laser: pointed ore (quartz, sapphire) at the probe tip, advantageous for penetration into the mucous membrane, (4) semiconductor laser: very already present For example, a laser widely used in the field is preferably used.

  Thus, by including one type of insulating material and one type of energizing material, or two types of insulating material, two types of materials (for example, a white insulating material and a green energizing material) are formed into two layers, and the submucosa and muscle layer. It is possible to inject a biocompatible material between the two. Even for an unskilled surgeon who is not highly skilled in ESD, the endoscope injection tool 100 having this double lumen structure is used in combination with an endoscope (not shown), and the stomach is used as a lower layer. Two types of injections, a white injection material (white insulating material 164) for preventing perforation of the skin and a colored injection material (green conductive material 168) to be injected for excision as an upper layer, can be locally injected. A protective sheet (white insulating material 164) for preventing perforation and a laser absorbing sheet (green conductive material 168) provided thereon can be formed in advance between the submucosa and the muscle layer.

  As a result, a laser light source that is similarly provided in the surgical kit and that has been previously matched in wavelength (for example, green wavelength) with respect to two types of materials (for example, white insulating material 164 and green conductive material 168); The endoscope laser probe 172 that can be connected to the laser light source is combined and used in the endoscope, thereby eliminating the necessity of sliding the detailed conditions on the user side, and lower white The sheet (white insulating material 164) does not absorb the laser energy of the green laser 170, but the upper diagno green layer (green conductive material 168) can be excited by the laser energy of the green laser 170. In other words, it becomes possible to perform laser treatment that can recover a cancer excision by local injection of two substances, so that an unskilled surgeon who does not have a high level of ESD skill mistakenly mistakenly irradiates the stomach wall too strongly. Even so, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased. Furthermore, according to this surgical kit, the necessity for the wavelength (for example, green wavelength) to be rubbed against two types of biocompatible materials (for example, the white insulating material 164 and the green conductive material 168) on the user side can be omitted. As a result, labor costs and the like when performing ESD can be saved, and medical costs can be reduced.

<Embodiment 5: Modification of Surgical Kit for Endoscopic Resection>
The surgical kit for endoscopic resection according to the present embodiment has basically the same configuration as the surgical kit for endoscopic resection according to the above-described fourth embodiment, but three more It is different in that it includes an endoscopic treatment tool that can freely manipulate and raise the cancer mucous membrane by pulling up the clip and thread at hand.

  In this way, by providing an endoscope treatment tool that can freely manipulate and raise the cancer mucous membrane by pulling up three clips and a thread at hand, the endoscope can be inserted into a body cavity. The insertion can be performed only once, and the entire lesion can be reliably lifted, and can be easily excised without leaving the lesion. In other words, this endoscopic treatment tool embodies the concept of “Fool Proof”, which is a kind of safety idea, and therefore widens the field of view and work area of the operator, and inadvertently, a high-frequency knife, etc. It is possible to reduce the possibility of making mistakes that cut too deeply into the stomach wall or the like.

  An endoscope treatment tool 10 used in Embodiment 5 will be described with reference to FIGS. 3 is an exploded perspective view of the endoscope treatment tool 10 used in the fifth embodiment, and FIG. 4 is a perspective view after assembly of the endoscope treatment tool 10 used in the fifth embodiment. FIG. 5 is a partially enlarged perspective view of a fixture for using the endoscope treatment tool of FIG. 4.

  The endoscope treatment tool 10 used in the fifth embodiment includes a gripping tool 11 and an extremely fine thread 15 connected to a base portion 14 that is a connecting portion of a pair of claws 12 and 13 of the gripping tool 11. This grasping tool 11 is for grasping a lesioned part. For example, the surface of a clip (trade name: HX-600-090) commercially available from Olympus Optical Co., Ltd. is formed from silicon nitride by plasma CVD. What formed the insulating film used was used. As the insulating film, not only silicon nitride but also silicon oxide can be used, and a method of forming an insulating film made of silicon nitride or silicon oxide by plasma CVD is used for manufacturing a liquid crystal display panel or a semiconductor element, for example. Since it is commonly employed in the field and is well known, its detailed description is omitted.

  Of the gripper 11, the indwelling portion 11 ′ is provided movably around a pair of claw portions 12 and 13 coupled to each other at the base portion 14 and between the claw portions 12 and 13 and the base portion 14. And a presser ring 16. The claw portions 12 and 13 have their tip portions bent toward each other's claw portions, and these bent tip portions 12 a and 13 a can be opened and closed by operating the presser ring 16. That is, the claw portions 12 and 13 are bent in a direction in which the intermediate portions in the length direction intersect and the rear end sides of the intersecting portions are separated from each other to form action portions 12b and 13b. Further, the rear end sides of the two are coupled to each other to form a base portion 14, and the base portion 14 is inserted into the presser ring 16 while being coupled with a very fine thread 15.

  The presser ring 16 and the claw portions 12 and 13 are assembled so as to be movable with respect to each other. When the presser ring 16 is moved relatively toward the tip portions of the claw portions 12 and 13, the presser ring 16 is moved to the action portion 12b, When the cover 13b is covered, the tip portions 12a and 13a of the claw portions 12 and 13 are opened, and when the presser ring covers the tip portions 12a and 13a of the claw portions 12 and 13, the claw portions 12 and 13 are reversed from the outside. Pressed down. Thereby, the state which the front-end | tip parts 12a and 13a of the nail | claw parts 12 and 13 closed can be maintained. In this state, the base portion 14 is exposed from the end portion of the presser ring 16.

  On the other hand, the base portion 14 of the claw portions 12 and 13 is detachably fitted into a notch hole 18 provided at one end portion of the connecting plate 17 that is passed through the presser ring 6, so that the gripping tool 11 is attached. Composed. The connecting plate 17 is longer than the presser ring 16, and when the base portion 14 is positioned at the end in the presser ring 16, the engagement hole 19 provided at the end opposite to the connecting plate 17 has a presser ring. 16 is exposed from the end. Then, the fine thread 15 connected to the base portion 14 of the claw portions 12 and 13 extends outside through the presser ring 16.

  The endoscope treatment tool 10 according to the fifth embodiment composed of the gripping tool 11 and the ultrafine thread 15 is gripped by the lesioned part as follows using the mounting tool 20 as shown in FIG. FIG. 5 is a partially enlarged perspective view of the fixture 20, and the left end tip is enlarged. The fixture 20 includes an insertion portion 21 and an operation portion 22. The distal end portion of the insertion portion 21 is provided with a fixing member 23 for holding the gripping tool 11 and a pin 24 for connecting to an engagement hole 19 provided in the connecting plate 17 of the gripping tool 11 at the distal end portion. The operation wire 25 is connected to the rear end portion of the fixing member 21. The operation wire 25 is passed through the first flexible sheath 26 made of a coil sheath, and is connected to the slider 28 through the tube joint 27 of the operation portion 22. The slider 28 passes the operation wire 25 through the operation wire 25. The movement and rotation of the fixing member 23 can be controlled.

  The first flexible sheath 26 is coupled to the ring 30 through the tube joint 27 and the slider 28. Further, the outside of the first flexible sheath 26 is covered with a second flexible sheath 29 made of a synthetic resin sheath, and the second flexible sheath 29 is covered with the tube joint 27 of the operation portion 22. The tube joint 27 can control the movement and rotation of the second flexible sheath 29. The tube joint 27 used in the fifth embodiment is provided with a hole 31 for passing an extremely fine thread.

  After that, when the engagement hole 19 provided at the end of the coupling plate 17 of the gripping tool 11 is fitted to the pin 24 of the fixing member 23 and then the gripping tool 11 is pulled lightly toward the distal end side, the gripping tool 11 becomes the fixing member. 23. Next, when the slider 28 is moved to the ring 30 side, the operation wire 25 and the fixing member 23 are drawn into the first flexible sheath 26, and the holding ring 16 of the gripper 11 is moved to the first flexible sheath 26. The tip is fitted and fixed. In this state, the tip portions 12a and 13a of the claw portion of the gripping tool 11 are slightly closed. In this state, the fixing member 23 to which the gripper 11 is fixed, the operation wire 25 and the first flexible sheath 26 are integrally inserted into the tube joint 27, and the tube joint 27 is separated from the slider 28. When moved in this manner, the gripping tool 11 is inserted into the second flexible sheath 29 without being exposed from the tip of the second flexible sheath 29.

  Then, the insertion portion 21 of the fixture 20 is inserted from a forceps insertion port (not shown) of the endoscope 32 that has been inserted into the body cavity in advance and protruded from the distal end portion 34 of the endoscope 32, and the endoscope 32. It is guided to the vicinity of the lesioned part 51 so as to be within the visual field. When the tube joint 27 and the slider 28 are adjacent to each other by pulling the tube joint 27 in the vicinity of the lesioned part 51, the second flexible tube 29 is pulled up and the gripping tool 11 is exposed. At this time, the very fine thread 15 connected to the base portion 14 of the claw portions 12 and 13 in the gripping tool 11 passes through the holding ring 16 to form the first flexible sheath 26 and the second flexible sheath 29. It is in a state of extending to the outside through a thread hole 31 provided in the tube joint 27 of the operation portion 22 through the space.

  Here, when the slider 28 is further moved slowly to the ring side 30, the presser ring 16 of the gripping tool 11 presses the action portions 12b and 13b of the claw portion, so that the tip portions 12a and 13a of the claw portion of the gripping tool 11 are Open wide. In this state, when the tip portions 12a and 13a of the nail part of the gripping tool 11 are pressed against the portion to be gripped of the lesioned part 51 and the slider 28 is pulled slowly, the presser ring 16 of the gripping tool 11 is moved to the tip part of the nail part. Since the pressure reaches the vicinity of 12a and 13a, the tip portions 12a and 13a of the claw bite into the lesioned part 51 and grip the lesioned part 51. At the same time, the notch 18 of the base 14 and the connecting plate 17 is exposed, so that the connecting plate 17 can be detached from the base 14 of the claws 12 and 13 by operating the operating portion 22. The indwelling portion 11 ′ consisting only of the claw portions 12 and 13 and the pressing ring 16 of the gripping tool 11 remains fixed.

  Then, by pulling out the tube joint 27, the slider 28, and the ring 30 simultaneously, the fixing member 23, the operation wire 25, the first flexible sheath 26, and the second flexible sheath 29 holding the connecting plate 17 are removed. Pull out. Then, as shown in FIG. 6, the very fine thread 15 extending from the indwelling portion 11 ′ passes through the forceps hole 37 of the endoscope 32 and extends to the outside from a forceps insertion opening (not shown). FIG. 6 is a schematic diagram showing the state of the vicinity of the distal end portion of the endoscope 32 in the vicinity of the lesioned part 51. Reference numeral 35 denotes an observation window, reference numeral 36 denotes an illumination window, and reference numerals 37 and 38 denote forceps holes, respectively. However, since these structures are all well-known, detailed description is omitted.

  In this state, the indwelling portion 11 ′ can be lifted by pulling the fine thread 15 from the outside, and the lesioned portion 51 can be lifted. However, if the lesioned portion 51 is large and needs to be lifted at a plurality of locations, the above operation is performed. Repeat it. At this time, another gripping part may be attached to the extracted endoscope treatment tool and reused. However, a necessary number of endoscope treatment tools 20 each having the gripping tool 11 attached to the fixing member 23 are prepared in advance. In addition, it is desirable to use a replacement because the treatment time can be shortened. In this way, the lesioned part 51 can be grasped by the plurality of indwelling portions 11 ′ through the single forceps hole 37, and the plurality of ultrafine threads 15 extending from the plurality of indwelling portions 11 ′ are also included. It can be in a state extending through the forceps hole 37 to the outside from the forceps insertion opening. In this state, when each ultrafine thread 15 is pulled from the outside, the lesioned part 51 is raised upward in a tent shape.

<Embodiment 6: Surgical method using surgical kit for endoscopic resection>
In the present embodiment, a surgical method using the surgical kit for endoscopic resection according to the fifth embodiment will be described below with reference to the drawings. As described above, first, using the endoscope treatment tool 10 according to the fifth embodiment, as shown in FIG. 6, by pulling up three clips and a thread by hand, the cancer mucous membrane can be operated freely. By raising, the IT knife 57, snare and the like are inserted from another forceps insertion port 38 of the endoscope 32 in the same manner as in the conventional example in a state where the lesioned portion 51 is raised upward in a tent shape. Then, incision and peeling of the lesioned part 51 are performed. Here, it is preferable to use an IT knife 57 having a mechanism in which an insulating white ceramic ball is attached to the tip of a high-frequency rod-shaped knife so that stomach perforation does not easily occur even when the knife is pressed. If such an IT knife 57 is used, the possibility of gastric wall perforation that opens a hole in the stomach due to gastric wall endoscopic surgery can be reduced, and the safety of ESD can be increased.

  Note that, depending on the relationship between the position of the lesioned part 51 and the direction in which the ultrathin thread 15 extends, there may occur a case where the lesioned part 51 cannot be raised in a desired direction even if the ultrathin thread 15 is pulled from the outside. In this case, a tube joint 27 to which a flexible sheath 29 ′ having a distal end bent by a predetermined angle is prepared, and a plurality of tube joints 27 extending from the distal end of the flexible sheath 29 ′ to the outside from the forceps insertion port are prepared. The entire fine thread 15 is taken out from the opening on the slider side of the tube joint 27. Then, the flexible sheath 29 ′ with the distal end bent is inserted again from the forceps insertion opening of the endoscope 32, and the distal end of the flexible sheath 29 ′ with the distal end bent is the endoscope 32. It protrudes from the forceps hole 37. Next, by rotating the tube joint 27, as shown in FIG. 7, the distal end portion of the flexible sheath 29 ′ whose distal end portion is bent is away from the lesioned portion 51, more specifically, the flexible sheath. The tip end portion 29 'is positioned in the direction in which the lesioned portion 51 is to be raised. In this state, when each ultrafine thread 15 is pulled from the outside, the lesioned part 51 is raised upward in a tent shape. Therefore, as shown in FIG. 8, an IT knife 57 is inserted from another forceps insertion port 38 of the endoscope 32, and the lesioned part 51 is incised and separated.

  In this way, even when the IT knife 57 is suddenly inserted from another forceps insertion port 38 of the endoscope 32 and the incision and separation of the lesioned part 51 are performed, the insertion of the endoscope into the body cavity can be performed only once. Moreover, the entire lesion can be reliably lifted and can be easily excised without leaving the lesion. In other words, the above-mentioned technique is an embodiment of the concept of “Fool Proof”, which is a kind of safety idea. Therefore, the surgeon widens the field of view and working area of the surgeon, and inadvertently attaches a high-frequency knife or the like to the stomach wall or the like. The possibility of making mistakes that are too deeply cut can be reduced.

  However, in the surgical method of the present embodiment, the IT knife 57 is suddenly inserted from another forceps insertion port 38 of the endoscope 32 as described above, and the incision and separation of the lesioned part 51 are not performed. In addition, as shown in FIG. 9, the endoscope injection tool 100 described in the first embodiment, which is separately introduced into the digestive organ through a channel of the endoscope body, is used. That is, first, using the endoscope injection device 100, the liquid feeding tube 121 is heated by the heating wire 110 arranged along the tube axis direction of the liquid feeding tube 121, and the biocompatible insulating material is used. The material is fed through the liquid feeding tube 121. Then, this insulating material is poured into the gap between the submucosal layer and the muscular layer formed by the lesioned part 51 being raised upward in a tent shape.

  In this way, as shown in FIG. 8, even if an unskilled operator who is not highly skilled in ESD, the endoscope injection tool 100 is used in combination with an endoscope (not shown). By injecting a biocompatible insulating material between the submucosa and the muscle layer in advance, it is possible to form a protective sheet 55 between the submucosa and the muscle layer in advance so as to prevent perforation. Become. Therefore, by using this endoscope injection tool 100 together with an endoscope (not shown), an unskilled operator who is not highly skilled in ESD uses an IT knife 57 as shown in FIG. Even when the IT knife 57 is accidentally cut deeply into the stomach wall 54 when the lesioned part 51 is incised or peeled off, the protective sheet 55 is made of an insulating sheet, so it can be cut with a high-frequency knife. Can not. That is, the protective sheet 55 made of an insulating material is obstructed when cutting deeply into the stomach wall 54, and the possibility of gastric wall perforation that opens a hole in the stomach by gastric wall endoscopic surgery can be reduced, thereby improving ESD safety. it can. Moreover, since this protective sheet 55 has biocompatibility, it is decomposed by digestive enzymes after excision.

  Thus, according to the principle that the mucous membrane resection method uses Joule heat generated by high-frequency current, an insulator that does not conduct electricity cannot be cut. Therefore, it becomes possible to use the insulating material protection sheet in the high frequency excision to prevent perforation. This is exactly because the insulating material, which has been used as a white ball for preventing gastric perforation by the IT knife 57, is provided on the side of the object to be incised by the IT knife 57 by the idea of reversal. It is based on a revolutionary idea.

<Embodiment 7: Modification of Surgical Method Using Surgical Kit for Endoscopic Resection>
The surgical method using the surgical kit for endoscopic resection according to the present embodiment is basically the same as the surgical method using the surgical kit for endoscopic resection according to the sixth embodiment. As shown in FIG. 10, the endoscope injection device 100 has the double lumen structure described in the third embodiment, and the insulating material having biocompatibility has a predetermined wavelength (for example, a green wavelength). The difference is that two kinds of biocompatible materials (for example, a white insulating material 164 and a green conductive material 168) having different contents of the dye that absorbs the laser beam 170 are included. In this surgical method, a laser light source capable of oscillating a laser beam having a predetermined wavelength (for example, a green laser beam 170 having a green wavelength), an endoscope laser probe 172 connectable to the laser light source, Is used.

  As described above, by including two types of biocompatible materials (for example, the white insulating material 164 and the green conductive material 168), two types of biocompatible materials can be used using the endoscope injection device 100 having a double lumen structure. (For example, white insulating material 164 and green energizing material 168) are made into two layers, and biocompatible insulating material (white insulating material 164) and energizing material (green energizing material 168) are injected between the submucosa and muscle layers. It becomes possible to do. Even for an unskilled surgeon who is not highly skilled in ESD, the endoscope injection tool 100 having this double lumen structure is used in combination with an endoscope (not shown), and the stomach is used as a lower layer. Two types of injections, a white injection material (white insulating material 164) for preventing perforation of the skin and a colored injection material (green energization material 168) to be injected for excision as an upper layer, can be locally injected. A protective sheet for preventing perforation and a laser absorbing sheet provided thereon can be formed in advance between the submucosa and the muscle layer.

  As a result, similarly, a laser that is provided in the surgical kit and has already been subjected to the wavelength (for example, green wavelength) sliding with respect to two types of biocompatible materials (for example, the white insulating material 164 and the green conductive material 168). By using the light source and the endoscope laser probe 172 that can be connected to the laser light source in combination with the endoscope, there is no need to slide the detailed conditions on the user side. The lower white sheet (white insulating material 164) does not absorb the laser energy, but the upper diagno green layer (green conductive material 168) can be excited by the laser energy. In other words, it becomes possible to perform laser treatment that can recover a cancer excision by local injection of two substances, so that an unskilled surgeon who does not have a high level of ESD skill mistakenly mistakenly irradiates the stomach wall too strongly. Even so, the possibility of gastric wall perforation that opens a hole in the stomach by endoscopic surgery can be reduced, and the safety of ESD can be increased. That is, the local injection method and the dye reaction laser that can be made into two layers enable a treatment method with further improved safety. Furthermore, according to this surgical kit, since the necessity of sliding the wavelength (for example, green wavelength) on two kinds of materials (for example, white insulating material and green conductive material) can be omitted on the user side, It can save labor costs when doing so and can contribute to medical cost control.

  Furthermore, as a feature of the conventional endoscopic laser treatment, the laser irradiated from the probe tip may go straight to infinity and damage the gastric mucosa on the opposite side. The emitted laser may damage the contralateral gastric mucosa. Therefore, in order to overcome this drawback, as shown in FIG. 20, a side portion of the probe tip is emitted by laser within a range of 5 to 40 mm just like a violin bow, and a claw portion 178 facing the base portion 180 at the tip. It is preferable to use an endoscope laser probe that can absorb laser energy. In this way, even if an unskilled surgeon misfires the laser, the gastric mucosa on the opposite side is not damaged, and safety can be further improved.

  As shown in FIG. 20, the endoscope laser probe has a structure in which a laser is irradiated like a violin bow, and the others are covered with an insulating flexible tube. More specifically, in this laser irradiation probe treatment tool, one end of a tube is cut off at a distal end portion of a normal endoscope laser probe within a range of 5 mm to 40 mm from the distal end, and processed into a semicircle in a sectional view. A pair of claw portions 178 opposed to the base portion 180 provided to absorb the laser energy emitted from the base portion 180 at the tip of the semicircular flexible tube, and a claw portion 178 A quartz fiber 176 provided in an opposed proximal section for guiding a laser generated from a laser light source and irradiating the laser in a range of 5 mm to 40 mm like a violin bow; Have. For this reason, the surgeon slides the endoscope laser probe to the side, so that the submucosal layer can be efficiently peeled off and the cancer resection time can be shortened while maintaining safety. Thus, in order to be irradiated with a laser like a bow of a violin, the cross section of a semicircular flexible tube having a width of 5 mm or more and 40 mm or less is formed into a semicircle (may be a rod shape instead of a semicircle), What is necessary is just to produce the probe provided with the quartz fiber 176 from which the laser is exposed only on the side surface.

  This treatment method can be said to be a novel treatment method using a combination of a submucosal local injection substance and a dye reaction laser that can be formed into two layers. By using a dye reaction laser, a layer that absorbs laser energy, a laser energy, This is an epoch-making surgical method that artificially creates a layer with a color that does not absorb water in the submucosa. In this way, by using a dye-reactive laser, artificially creating a layer that absorbs laser energy and a layer that does not absorb laser energy in the submucosal layer, it is possible to provide suitable incision and safety of the lesion. It becomes possible to achieve both. Here, as a problem of the laser treatment, the conventional laser irradiation method cannot recover the excision of the cancer mucosa, and thus the laser treatment has been regarded as a palliative treatment rather than a radical treatment. However, according to this surgical method, the laser method, which is a palliative operation, can be converted into a radical operation with the idea of reversal.

  As mentioned above, although embodiment of this invention was described with reference to drawings, these are the illustrations of this invention, Various structures other than the above are also employable.

  For example, in the above embodiment, the liquid to be injected into the lesion to be raised is the same as that conventionally known, but fine particles that resonate with electromagnetic waves are further injected into the lesion to be raised to increase the energy. May be. In this case, a sensitizing substance such as verteporfin may be further injected.

  EXAMPLES Hereinafter, although an Example demonstrates this invention further, this invention is not limited to these.

<Example 1>
In preliminary experiments, it was found that injection of “fats” into the submucosal layer using ordinary commercially available local injection needles was impossible due to solidification of “fats” by cooling. In other words, it was found that when a liquid was injected to create a bulge, the beef tallow that had been liquefied by heating was re-solidified and blocked in the local injection needle, making it impossible to inject beef tallow. In order to overcome this disadvantage, a prototype of the local injection needle heating system, which is outlined in FIG. 2 described in the first embodiment, is prepared, and as described in the second embodiment, a temperature sensor is provided and the temperature is adjusted. The measurement data of was acquired.

  As already described in Embodiment 1, in the prototype, in order to increase the heating efficiency, a piano wire was wound around the coil in a spiral shape at intervals of 1 to 2 cm on the outside of the local injection needle. In addition, in order to prevent a short circuit, a straight piano wire was arranged inside the inner cylinder and spiraled around the outside to achieve insulation. Moreover, in order to prevent a piano wire from contacting, the introduction port of the piano wire was arranged 2 cm apart.

  Here, the temperature measurement data of the heating system of the local injection needle are shown in Tables 1 and 2 below. Tables 1 and 2 show the results of measuring whether the temperature at the tip, middle, etc. of the local injection needle is stable when a voltage is applied. Corresponding graphs are shown in FIGS.

  As a result, as shown in Tables 1 and 2, it was found that when a voltage of a general value was applied and 3 minutes passed, the target temperature was reached and a steady state was reached. As a result, when the power was turned on and the local injection needle was heated 3 minutes before injecting the fat, the fat could be delivered to the submucosa of the stomach in a liquid state. FIG. 11 shows the experimental results of cooling and solidifying the fat after being delivered to the submucosa of the stomach in a liquid state. As shown in FIG. 11, a pig stomach is used as an experimental model, and heated and liquefied beef tallow is injected as a white substance. After 5 minutes, beef tallow is solidified in a sheet form in the submucosal layer (white substance is It was confirmed that the sheet spreads between the mucous membrane and the muscle layer. As shown in Tables 1 to 2 and FIGS. 11 to 13, the temperature 3 minutes after turning on the power is a very stable (constant) temperature. It is thought that it was able to deliver smoothly to the submucosa.

  That is, in this prototype, an ultrafine nichrome wire was attached to a local injection needle and heated in the range of 40 ° C. to 95 ° C. to successfully develop a treatment instrument that can deliver fat to the submucosa.

  In the above, this invention was demonstrated based on the Example. It is to be understood by those skilled in the art that this embodiment is merely an example, and that various modifications are possible and that such modifications are within the scope of the present invention.

  For example, the endoscope itself may be heated with a nichrome wire so that fat does not recoagulate in the local injection needle. In this case as well, even if a configuration for heating the local injection needle itself is not provided, the endoscope cannula itself is heated with nichrome wire so that the fat does not recoagulate inside the local injection needle. Can do.

It is a block diagram for demonstrating the whole structure of the injection tool for endoscopes which concerns on Embodiment 1. FIG. It is the conceptual diagram which expanded and showed the internal structure of the front-end | tip part of the injection tool for endoscopes which concerns on Embodiment 1. FIG. It is a disassembled perspective view of the endoscope treatment tool used in Embodiment 5. It is a perspective view after the assembly of the endoscope treatment tool used in Embodiment 5. It is a partially expanded perspective view of the fixture for using the endoscope treatment tool of FIG. FIG. 5 is a perspective view showing a gripping state of a lesioned part by the endoscope treatment tool of FIG. 4 when excising the lesioned part. It is a perspective view which shows the lifting state of the lesioned part at the time of excising a lesioned part. It is a perspective view which shows the state which excises a lesion part with IT knife. It is a perspective view which shows the injection | pouring state of the insulating material which has biocompatibility between a submucosa and a muscular layer. It is a perspective view for demonstrating the case where the injection tool for endoscopes which has a double lumen structure is used. It is a photograph when beef tallow is injected between the submucosa and the muscle layer. It is a time-surface temperature change figure in the voltage of 37V of the local injection needle made as an experiment in Example 1. It is a time-surface temperature change figure in 55 V of voltage of the local injection needle made as an experiment in Example 1. 14 (a) to 14 (d) are perspective views showing a conventional operation during excision of a lesion. It is AA sectional drawing of FIG.14 (b). It is BB sectional drawing of FIG.14 (c). It is a figure which shows the use condition of the magnetic anchor guidance apparatus in the stomach of a prior art example. It is a perspective view of the endoscope treatment apparatus of another conventional example. It is a conceptual diagram for demonstrating the conventional laser irradiation method. It is a conceptual diagram for demonstrating the laser irradiation method which can irradiate a laser like the bow of a violin.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Endoscopic treatment tool 11 Grasping tool 11 'Grasping tool indwelling part 12, 13 Claw part 12a, 13a Claw part tip part 12b, 13b Claw part action part 14 Base 15 Extra fine thread 16 Holding ring 17 Connecting plate 18 Notch hole 19 Engagement hole 20 Fixture 21 Insertion part 22 Operation part 23 Fixing member 24 Pin 25 Operation wire 26 First flexible sheath 27 Tube joint 28 Slider 29 Second flexible sheath 29 ' Bent second flexible sheath 30 Ring 31 Thread hole 32 Endoscope 33 Forceps insertion port 34 Endoscope tip 35 Observation window 36 Illumination windows 37 and 38 Forceps hole 51 Lesions 52 Marking 53 Mucosal layer 54 Muscle layer 57 IT knife 101 Outlet portion 102 Grip 105 Mantle tube 108 Port 109 Slider 110 Heating wire 111 Lead wire 112 Heating power supply 121 Liquid feeding tube 164 white insulating material 166 holes 168 green energization material 170 within the green laser beam 172 endoscopic laser probe 174 stomach 176 silica fiber 178 pawl portion 180 base portion

Claims (11)

A surgical kit for endoscopic resection,
An endoscope injection tool;
A biocompatible material;
A laser light source of a predetermined wavelength;
An endoscope laser probe connectable to the laser light source;
With
The endoscope injection tool is
An outer tube formed by a flexible tube;
A pouring part provided so as to be partly projectable from the tip of the outer tube;
A liquid feeding tube provided in the outer tube and communicating with the dispensing portion;
A connection port with the syringe body provided at the rear end of the liquid feeding tube;
An electric heating material arranged along the tube axis direction of the liquid feeding tube;
An electrical connector provided at a rear end of the electric heating material;
With
The liquid feeding tube has two or more lumens separated from each other,
The pouring part has two or more spouts communicating with the two or more lumens, respectively.
The two or more spouts are two or more flat spouts parallel to each other,
The two or more lumens or the two or more extraction ports are provided with colors, symbols, figures, or shapes that can be distinguished from one another with the naked eye,
The electric heating material is a heating wire consisting of one or more sets of a forward path and a backward path,
The forward path is spirally provided in the gap between the outer tube and the liquid feeding tube,
The return path is linearly provided inside the liquid feeding tube,
The heating wire is
Electric resistivity 1.0 × 10 ⁻⁷ Ω · m or more and 1.6 × 10 ⁻⁶ Ω · m or less and cross-sectional area 7.85 × 10 ⁻³ mm ² or more and 1.25 × 10 ⁻¹ mm ² or less Heat rays,
In the spiral region, a spiral diameter of 1.0 mm to 5.0 mm and a spiral interval of 5 mm to 20 mm are provided,
The biocompatible material includes one or more materials selected from the group consisting of animal-derived natural fats and oils, plant-derived natural fats and oils, agar, silicon, polymethyl methacrylate, rubber, cyanoacrylate, chitosan,
The biocompatible material includes one type of insulating material and one type of current-carrying material, or two types of insulating materials, each having a different content of the dye that absorbs the laser beam having the predetermined wavelength.
Surgery kit . The surgical kit according to claim 1, wherein
The electric heating material is configured to be capable of adjusting the temperature of the liquid feeding tube so that the temperature of the content of the liquid feeding tube is equal to or higher than the glass transition point of the content.
Surgery kit . The surgical kit according to claim 1, wherein
The electric heating material is configured to be capable of adjusting the temperature of the liquid feeding tube so that the viscosity of the contents of the liquid feeding tube is equal to or lower than a predetermined viscosity.
Surgery kit . The surgical kit according to claim 1, wherein
The electric heating material is configured to be capable of adjusting the temperature of the liquid feeding tube so that the melt flow rate of the contents of the liquid feeding tube is equal to or higher than a predetermined threshold.
Surgery kit . The surgical kit according to any one of claims 1 to 4,
The electric heating material is configured such that the temperature of the liquid feeding tube can be adjusted in a range of 40 ° C. or higher and 95 ° C. or lower.
Surgery kit . The surgical kit according to any one of claims 1 to 5 ,
A temperature sensor for measuring the temperature of the liquid feeding tube;
Surgery kit . The surgical kit according to claim 6 ,
Based on the measurement data obtained from the temperature sensor, feedback control is performed so that the value of the current or voltage input from the electrical connector to the electric heating material is controlled so that the temperature of the liquid feeding tube falls within a predetermined temperature range. A control unit;
Surgery kit . The surgical kit according to any one of claims 1 to 7 ,
The dispensing portion is a syringe needle;
Surgery kit . The surgical kit according to any one of claims 1 to 8 ,
The pouring part is provided so as to be freely accessible from the distal end of the outer tube,
The liquid supply tube is provided in the outer tube so as to freely advance and retract.
Surgery kit . The surgical kit according to any one of claims 1 to 9 ,
At the tip of the endoscope laser probe,
A flexible tube cut off from one end of the tube within a range of 5 mm to 40 mm from the tip and processed into a semicircle in a sectional view;
A pair of claws opposed to the base provided to absorb laser energy emitted from the base at the tip of the semicircular flexible tube;
Quartz provided for guiding the laser generated from the laser light source provided in the proximal cross section facing the claw part and irradiating the laser in the range of 5 mm to 40 mm like a violin bow Fiber,
A probe treatment tool for laser irradiation having
Surgery kit. The surgical kit according to any one of claims 1 to 10 ,
A pair of freely openable / closable claw parts coupled to each other at the front ends and the pair of claw parts inserted therein and provided so as to be relatively movable along the pair of claw parts. A presser ring capable of closing the claw part, and a notch hole inserted into the presser ring, a notch hole at one end and an engaging hole at the other end, and the notch hole A gripping plate provided with a base plate of a pair of claw portions detachably engaged, a very fine thread connected to the base portions of the pair of claw portions and extending through the presser ring, An endoscopic treatment instrument characterized by comprising:
Surgery kit.