JP2016032523A - Cellular tissue transection method - Google Patents

Abstract

Provided is a method for safely and efficiently separating a cellular tissue of a mucosal layer. A submucosal layer 88 and a mucosal layer 89 are laminated on a muscle layer 87, and a tumor 92 in the mucosal layer 89 is separated. At this time, the first liquid is injected into the submucosa 88 between the mucosa layer 89 and the muscle layer 87, the mucosa layer 89 around the tumor 92 is incised, and the submucosa between the mucosa layer 89 and the muscle layer 87. The second liquid 98 is sprayed and injected into 88, and the mucosa layer 89 and the muscle layer 87 are separated by the electric knife 71 in the submucosal layer 88 where the second liquid 98 is injected. [Selection] Figure 8

Description

  The present invention relates to a cell tissue separation method.

  Early tumors may form on the mucosa on the surface of digestive organs such as the esophagus, stomach, and large intestine. At this time, submucosal dissection is widely performed in which the submucosa is removed with an electric knife or the like. A method using an electric knife is disclosed in Patent Document 1. According to this, a high-frequency current was passed through the knife part to separate the submucosa. In addition, methods using a liquid ejecting apparatus are disclosed in Patent Document 2 and Patent Document 3. According to this, the liquid was ejected from the liquid ejecting apparatus and injected into the submucosa. Thereby, the mucous membrane layer was protruded.

JP 2013-111308 A JP 2004-105367 A International Publication No. 2006/012391

  In Patent Document 1, since an incision is made with an electric knife, an incision can be made very well even with a flexible organ of the digestive system. Therefore, incision can be performed efficiently. However, incision with an electric scalpel is liable to damage other tissues such as a muscle layer below the mucous membrane, and there is a risk of forming a perforation or the like by mistake. In Patent Document 2, since a liquid is ejected and incised, it is relatively difficult to damage a living tissue. However, it is necessary to increase the output to make a flexible mucosal incision. At this time, since the liquid is ejected toward the muscle layer in order to incise the mucous membrane, there is a high possibility of damaging the muscle layer and the like. In patent document 3, it peels only with a liquid. The organs of the digestive system are very flexible because of their ability to flow food. When a digestive organ is incised with a liquid, it is difficult to make an efficient incision. Therefore, there has been a demand for a method for safely and efficiently separating the cellular tissue of the mucosal layer.

  The present invention has been made to solve the above-described problems, and can be realized as the following forms or application examples.

[Application Example 1]
The cell tissue separation method according to this application example is a cell tissue separation method in which a submucosal layer and a mucosal layer are laminated on a muscle layer, and the cell tissue in the mucosal layer is separated. Injecting the first liquid into the submucosa between the muscle layers, incising the mucosa layer surrounding the cellular tissue, and spraying the second liquid into the submucosa between the mucosa layers and the muscle layers The mucous membrane layer and the muscle layer are separated by a cutting tool at the submucosal layer where the second liquid is injected.

  According to this application example, the submucosal layer and the mucosal layer are laminated on the muscle layer, and the cell tissue to be separated is located in the mucosal layer. Then, the first liquid is injected into the submucosa layer between the mucosa layer and the muscle layer. Thereby, a mucous membrane layer protrudes with respect to a muscular layer. Then, an incision is made in the mucosal layer around the cell tissue. Since the mucosal layer protrudes from the muscle layer, it can be easily incised.

  Next, the second liquid is injected and injected into the submucosa layer between the mucosa layer and the muscle layer. As a result, liquid accumulates in the submucosa between the mucosa layer and the muscular layer, and the submucosa swells. . Then, the mucosa layer and the muscle layer levitated in the submucosa layer are cut off with a cutting tool. At this time, since the cutting tool can be inserted in a shape almost parallel to the muscle layer and the submucosa, the mucosa layer can be easily peeled from the muscle layer in the submucosa. Therefore, damage to the muscle layer can be suppressed. Moreover, it can peel easily in a short time compared with the case where the submucosal layer between the muscle layer and the mucosal layer is narrow. As a result, the cell tissue can be separated safely and efficiently.

[Application Example 2]
In the cell tissue separation method according to the application example, when the mucosa layer and the muscle layer are separated by the separation tool in the submucosa layer, blood vessels remaining between the mucosa layer and the muscle layer Is stopped using a hemostatic device.

  According to this application example, the blood vessel remaining between the mucosa layer and the muscle layer into which the second liquid has been injected is hemostatic using the hemostasis device. Therefore, since the visibility is not hindered by blood, the cell tissue can be separated safely and efficiently.

[Application Example 3]
In the cell tissue separation method according to the application example, when the second liquid is injected, an endoscope is inserted between the mucosal layer and the muscle layer, and the submucosal layer is pressed by the endoscope. It is characterized by doing.

  According to this application example, stress is applied in the direction in which the mucosal layer is peeled from the muscle layer in the submucosal layer by the endoscope. Thereby, even if the submucosal layer is flexible, a part of the mucosal layer and the muscle layer can be easily peeled off in the submucosal layer without strongly ejecting the liquid, and the mucosal layer can be floated. Therefore, damage to the muscle layer can be suppressed.

[Application Example 4]
In the cell tissue separation method according to the application example, when the first liquid is injected, the first liquid is injected and injected.

  According to this application example, the first liquid and the second liquid are injected and injected. Therefore, the same apparatus can be used as the apparatus for injecting the first liquid and the apparatus for injecting the second liquid. As a result, preparation for cell tissue separation can be facilitated.

[Application Example 5]
In the cell tissue separation method according to the application example, the first liquid is ejected from a nozzle, and the first liquid is ejected by contacting the nozzle with the mucosal layer.

  According to this application example, the first liquid is ejected in a state where the nozzle is in contact with the mucosal layer. At this time, the liquid immediately after being ejected from the nozzle has a high flow velocity and is thin. Therefore, the liquid is prevented from diffusing on the surface of the mucosal layer and can penetrate the mucosal layer. Thereafter, the liquid diffuses in the submucosa. As a result, the liquid can be reliably injected and the muscle layer can be prevented from being damaged.

[Application Example 6]
In the cell tissue separation method according to the application example, the second liquid contains a drug.

  According to this application example, the second liquid contains a medicine. Therefore, the effect of the drug can be exerted at the place where the cell tissue is cut off. When the drug has hemostatic ability, microhemorrhage from small blood vessels can be reduced. When the drug has wound healing efficacy, it can reduce early healing of ulcers and post bleeding. When the drug is an anticancer drug, the local recurrence rate of cancer can be reduced.

[Application Example 7]
In the cell tissue separation method according to the application example, after separating the mucosa layer and the muscle layer in the submucosa layer, the liquid containing the drug is sprayed and applied to the remaining muscle layer. It is characterized by.

  According to this application example, the liquid containing the drug is applied after the mucous membrane layer and the muscle layer are separated in the submucosal layer. Therefore, the effect of the drug can be exerted at the place where the cell tissue is cut off.

(A) is a block diagram showing a structure of a liquid ejecting apparatus, (b) is a partial schematic side view showing a structure of a nozzle of the liquid ejecting apparatus, and (c) is a liquid in the nozzle. Schematic diagram for explaining the behavior of the. (A) is a schematic cross section which shows the internal structure of a pulsation provision part, (b) is a graph which shows transition of the volume of a liquid chamber. The electric control block diagram of a liquid ejecting apparatus. The schematic perspective view which shows the structure of an endoscope. (A) is a schematic side sectional view showing the structure of an endoscope syringe, (b) is a schematic side sectional view showing the structure of an electric knife, and (c) is a schematic side sectional view showing the structure of a hemostatic forceps. The flowchart which shows the cell tissue cutting method. The schematic diagram for demonstrating the cell tissue cutting method. The schematic diagram for demonstrating the cell tissue cutting method. The schematic diagram for demonstrating the cell tissue cutting method. The schematic sectional side view for demonstrating the method to cut | disconnect the cell tissue in connection with 2nd Embodiment. The typical sectional side view for demonstrating the method to cut | disconnect the cell tissue in connection with 3rd Embodiment. The typical sectional side view for demonstrating the method to cut | disconnect the cell tissue in connection with 4th Embodiment.

  In this embodiment, a characteristic example of a liquid ejecting apparatus and a method of separating a cell tissue using the liquid ejecting apparatus will be described with reference to the drawings. Hereinafter, embodiments will be described with reference to the drawings. In addition, each member in each drawing is illustrated with a different scale for each member in order to make the size recognizable on each drawing.

(First embodiment)
In the present embodiment, a liquid ejecting apparatus that is a surgical instrument and a method for separating a cell tissue using the liquid ejecting apparatus will be described with reference to FIGS. FIG. 1A is a block diagram illustrating a structure of the liquid ejecting apparatus. FIG. 1B is a partial schematic side view showing the structure of the nozzle of the liquid ejecting apparatus. The liquid ejecting apparatus 1 according to the present embodiment is a medical device used in a medical institution, and has a function as a scalpel that performs incision or excision of an affected part by ejecting liquid onto the affected part. Furthermore, it has a function of injecting liquid into the affected area. It can also be used to treat animals other than humans and to dissect corpses.

  As shown in FIG. 1A, the liquid ejecting apparatus 1 includes a case 2. Case 2 is held by a surgeon or an assistant as needed when performing surgery, or attached to a predetermined place. The case 2 may be referred to as a handpiece, a grip part, or an operation part. The operator is also referred to as an operator in scenes other than surgery. The case 2 is provided with an injection pipe 3 as a fluid flow path. The ejection tube 3 is flexible and can be used in an endoscope. A nozzle 4 is installed at one end of the ejection pipe 3 as a liquid ejection opening for ejecting fluid. A pulsation imparting portion 5 is installed at the other end of the ejection pipe 3. A filter 7, a flow meter 8, an electromagnetic valve 9, and a pump 10 are connected to the pulsation imparting unit 5 through a tube 6 in this order. The pulsation imparting part 5 inside the case 2 is a part that makes the fluid that passes through it a pulse flow.

  The filter 7 has a function of removing foreign substances, bacteria, bubbles and the like in the fluid. The flow meter 8 measures the flow rate of the fluid flowing through the tube 6. The flow meter 8 can be a hot wire flow meter, an impeller flow meter, or the like. The electromagnetic valve 9 is a valve whose opening and closing is controlled by an electric signal. The electromagnetic valve 9 can be a valve that opens and closes with a motor or electromagnet.

  The pump 10 can be a syringe type pump or a tube pump. In the case of a syringe type, it is preferable to install a device for supplying fluid into the syringe. Thereby, the liquid ejecting apparatus 1 can be continuously driven.

  A water inlet pipe 10 a is installed in the pump 10, and one end of the water inlet pipe 10 a is connected to the water storage tank 11. The water tank 11 contains a liquid 12. For the liquid 12, for example, physiological saline is used. Since physiological saline is not harmful to the living body, it can be used for surgery.

  The liquid ejecting apparatus 1 includes a control device 13 as control means, and the control device 13 controls the operation of the liquid ejecting apparatus 1. The pulsation imparting unit 5, the flow meter 8, the electromagnetic valve 9 and the pump 10 are connected to the control device 13 by a cable 13a.

  The control device 13 is provided with a main switch 14 and an injection switch 15. The main switch 14 is a switch that activates the liquid ejecting apparatus 1. When the main switch 14 is turned on, power is supplied to the control device 13. The ejection switch 15 is a switch for switching whether or not the liquid 12 is ejected from the nozzle 4. The injection switch 15 is a switch that is operated by an operator by stepping on the foot.

  When the surgeon turns on the main switch 14, the control device 13 is initialized. Next, the surgeon turns on the injection switch 15. The pump 10 is activated, and the pump 10 causes the liquid 12 to flow through the electromagnetic valve 9. And the control apparatus 13 opens the solenoid valve 9, and the liquid 12 with a high pressure turns into a fluid, and advances the tube 6. FIG. Then, the flow meter 8 detects the flow rate of the fluid traveling through the tube 6 and outputs it to the control device 13. The liquid ejecting apparatus 1 adjusts the driving of the pump 10 based on the detection result of the flow meter 8.

  The fluid traveling through the tube 6 passes through the filter 7. The filter 7 removes dust, bubbles, salt crystals, and the like from the liquid 12. The liquid 12 that has reached the pulsation imparting unit 5 is subjected to pulsed pulsation by the pulsation imparting unit 5. A pulsed pulsating flow is called a pulse flow. The liquid 12 that has passed through the pulsation imparting unit 5 passes through the ejection pipe 3 and is ejected from the nozzle 4. The liquid 12 passing through the nozzle 4 is ejected in a pulse flow. As shown in FIG. 1B, the injection tube 3 has a tubular shape centered on the nozzle 4. A pulse flow of liquid 12 is ejected from the nozzle 4.

  FIG. 1C is a schematic diagram for explaining the behavior of the liquid in the nozzle. As shown in FIG. 1 (c), the operator operates the case 2 to bring the nozzle 4 closer to the cell tissue 16. When the surgeon turns on the ejection switch 15, the liquid 12 is ejected from the nozzle 4, and the liquid 12 collides with the collision point 16 a of the cell tissue 16. A liquid pool 17 in which the liquid 12 is accumulated is formed around the collision point 16a. The cell tissue 16 is impacted around the collision point 16a. Then, the cell tissue 16 is softened by receiving an impact. When the impact is strong, a part of the cell tissue 16 is crushed and a hole is formed.

  Fig.2 (a) is a schematic cross section which shows the internal structure of a pulsation provision part. The pulsation imparting unit 5 is provided with an inlet channel 21, a liquid chamber 22, and an outlet channel 23 through which the liquid 12 supplied from the tube 6 passes. The inlet channel 21 and the outlet channel 23 are formed in the first case 24. The diaphragm 25 is installed so that the liquid chamber 22 is sandwiched between the first case 24 and the diaphragm 25. The tube 6 is connected to the inlet channel 21, and the injection pipe 3 is connected to the outlet channel 23.

  On the right side of the first case 24 in the drawing, a cylindrical second case 26 is installed in contact with the first case 24. The diaphragm 25 is a disk-shaped thin metal plate, and an outer peripheral portion of the diaphragm 25 is sandwiched and fixed between the first case 24 and the second case 26. A third case 27 is installed on the right side of the second case 26 in the drawing in contact with the second case 26. Between the diaphragm 25 and the third case 27, a piezoelectric element 28, which is a laminated piezoelectric element, is disposed. One end of the piezoelectric element 28 is fixed to the diaphragm 25, and the other end is fixed to the third case 27. The piezoelectric element 28 is connected to the control device 13 by a cable 13a.

  When a drive voltage is applied from the control device 13, the piezoelectric element 28 changes the volume of the liquid chamber 22 formed between the diaphragm 25 and the first case 24. When the drive voltage applied to the piezoelectric element 28 increases, the piezoelectric element 28 expands, and the diaphragm 25 is pushed by the piezoelectric element 28 and bends toward the liquid chamber 22 side in the first direction 29 in the figure. When the diaphragm 25 is bent in the first direction 29, the volume of the liquid chamber 22 is reduced. Then, the fluid in the liquid chamber 22 is pushed out of the liquid chamber 22. The inner diameter of the outlet channel 23 is larger than the inner diameter of the inlet channel 21. That is, the fluid resistance of the outlet channel 23 is smaller than the fluid resistance of the inlet channel 21. Since the inlet channel 21 is closer to the pump 10 than the outlet channel 23, the water pressure in the inlet channel 21 is higher than the water pressure in the outlet channel 23. Accordingly, most of the fluid in the liquid chamber 22 is pushed out of the liquid chamber 22 through the outlet channel 23.

  On the other hand, when the drive voltage applied to the piezoelectric element 28 decreases, the piezoelectric element 28 contracts, and the diaphragm 25 is pulled by the piezoelectric element 28 and bends toward the third case 27 in the second direction 30 in the drawing. The piezoelectric element 28 is reduced to increase the volume of the liquid chamber 22, and fluid is supplied from the inlet channel 21 into the liquid chamber 22.

  Since the drive voltage applied to the piezoelectric element 28 is repeatedly turned on (maximum voltage) and turned off (0 V) at a high frequency (for example, 300 Hz), the volume of the liquid chamber 22 is repeatedly expanded and reduced, and the fluid pulsates. Given. The fluid pushed out from the liquid chamber 22 is ejected as a pulse flow from the nozzle 4 at the tip of the ejection tube 3. The pulse flow injection means that the flow rate or the flow velocity is injected with fluctuation, and is not limited to repeating the fluid injection and the stop. That is, various injection forms such as a form in which the injection is completely interrupted between injections and a form in which a low-pressure flow exists between the injections are included.

  FIG. 2B is a graph showing the transition of the volume of the liquid chamber. 2B, the vertical axis indicates the volume of the liquid chamber 22, and the upper side in the figure is smaller than the lower side. The horizontal axis shows the transition of time, and the time transitions from the left side to the right side in the figure. The volume transition line 31 shows the transition of the volume when the volume of the liquid chamber 22 is changed.

  The volume transition line 31 is repeated at a period 32. One cycle 32 is divided into a rising section 33, a falling section 34, and a rest section 35. In the rising section 33, the volume transition line 31 has a shape similar to a sine waveform. At this time, a voltage is applied to the piezoelectric element 28 and the piezoelectric element 28 expands. As a result, the diaphragm 25 moves in the first direction 29 and the volume of the liquid chamber 22 decreases. Then, the liquid 12 in the liquid chamber 22 moves to the outlet channel 23.

  In the falling section 34, the volume transition line 31 has a shape similar to a sine waveform. At this time, the voltage applied to the piezoelectric element 28 decreases and the piezoelectric element 28 contracts. As a result, the diaphragm 25 moves in the second direction 30 and the volume of the liquid chamber 22 increases. Then, the liquid 12 flows from the inlet channel 21 into the liquid chamber 22. The falling section 34 is longer than the rising section 33. As a result, the liquid 12 vigorously flows out to the outlet channel 23 and flows from the inlet channel 21 at a low speed. The rest section 35 is a section in which the piezoelectric element 28 maintains a contracted state. The period 32 can be adjusted by changing the length of the pause section 35.

  A volume change amount in the volume transition line 31 is defined as a volume change amount 31a. The controller 13 controls the piezoelectric element 28 so that the volume change amount 31a can be adjusted. As described above, a pulse flow is formed in the pulsation imparting unit 5.

  FIG. 3 is an electric control block diagram of the liquid ejecting apparatus 1. In FIG. 3, the liquid ejecting apparatus 1 includes a control device 13 that controls the operation of the liquid ejecting apparatus 1. And the control apparatus 13 is provided with CPU36 (central processing unit) which performs various arithmetic processes as a processor, and the memory 37 which memorize | stores various information. The pump drive device 38, the flow meter 8 and the pulsation imparting unit 5 are connected to the CPU 36 via the input / output interface 41 and the data bus 42. Further, the main switch 14, the injection switch 15, the pulsation amount input device 43, the output device 44 and the input device 45 are also connected to the CPU 36 via the input / output interface 41 and the data bus 42.

  The pump drive device 38 is a device that drives the pump 10 and the electromagnetic valve 9. The pump drive device 38 receives an instruction signal from the CPU 36. Then, the pump drive device 38 drives the pump 10 under the conditions of pressure and flow rate indicated by the instruction signal. Further, the pump drive device 38 drives the electromagnetic valve 9 to open and close the valve.

  The main switch 14 is a switch that activates the liquid ejecting apparatus 1. When the main switch 14 is turned on, the control device 13 is activated. When the surgeon turns on the injection switch 15, the pump 10 and the pulsation imparting unit 5 are driven. Then, after the water pressure of the liquid 12 becomes high, the electromagnetic valve 9 is opened and the liquid 12 is ejected from the nozzle 4.

  The pulsation amount input device 43 is a device through which an operator inputs the fluctuation amount of the pulsation of the liquid 12. The pulsation amount input device 43 is a device for setting the volume change amount 31a of the liquid chamber 22, for example. The pulsation amount input device 43 can be configured by, for example, a variable resistor and a circuit or switch that converts the resistance value of the variable resistor into a voltage.

  In addition to the liquid crystal display device, the output device 44 includes a light and speaker for notifying abnormality, a device that performs wired and wireless communication with an external computer, and the like. Thereby, the control device 13 can display and output the state of the liquid ejecting apparatus 1 and the setting state set by the operator.

  The input device 45 includes a device that performs wired and wireless communication with an external computer, in addition to a keyboard, a mouse-type input device, and a pen-type input device. Various data are input to the memory 37 by these input devices 45.

  The memory 37 is a concept including a semiconductor memory such as a RAM and a ROM, and an external storage device such as a hard disk and a DVD-ROM. Functionally, in order to store a storage area for storing program software 46 in which a control procedure of the operation of the liquid ejecting apparatus 1 is described, and supply amount data 47 that is data used when calculating the supply amount of the liquid 12. Storage area is set. In addition, a storage area for storing pulsation data 48 that is data relating to the pulsation of the liquid 12 is set. In addition, a work area for the CPU 36, a storage area that functions as a temporary file, and other various storage areas are set.

  The CPU 36 performs control to eject the liquid 12 from the nozzle 4 of the case 2 according to the program software 46 stored in the memory 37. A pump control unit 49 is provided as a specific function realization unit. The pump control unit 49 outputs an instruction signal to the pump driving device 38 and controls the fluid to flow by driving the pump 10. The pump controller 49 inputs the flow rate of the liquid 12 detected by the flow meter 8 and controls the flow rate of the liquid 12 ejected. Further, the pump control unit 49 opens and closes the electromagnetic valve 9 to control the flow and stop of the liquid 12.

  In addition, the CPU 36 has a pulsation control unit 50. The pulsation control unit 50 inputs the pulsation data 48 set by the pulsation amount input device 43 from the memory 37. The pulsation control unit 50 controls the volume change amount 31 a of the liquid chamber 22 by controlling the piezoelectric element 28 of the pulsation imparting unit 5. As the liquid chamber 22 fluctuates, the liquid 12 is ejected in a pulse flow.

  In the present embodiment, the above functions are realized by program software using the CPU 36. However, when the above functions can be realized by a single electronic circuit (hardware) that does not use the CPU 36, It is also possible to use such an electronic circuit.

  The liquid ejecting apparatus 1 is used in combination with an endoscope. Next, the endoscope will be described. FIG. 4 is a schematic perspective view showing the structure of the endoscope. As shown in FIG. 4, the endoscope 53 includes an operation unit 54. The operation unit 54 has a substantially cylindrical shape, and an operation button 55 is provided on the operation unit 54. It is arranged so that the surgeon can hold the operation unit 54 with one hand and press the operation button 55.

  An insertion unit 56 is installed in connection with the operation unit 54. The insertion part 56 is a part to be inserted into the subject. The insertion portion 56 is a flexible tube, and an optical fiber for transmitting an image, an optical fiber for transmitting illumination light, a hole for exhaust and drainage, and a liquid ejecting apparatus 1 and the like are installed therein. A hole is installed. An imaging objective lens 58 is installed at the distal end portion 57 at the distal end of the insertion portion 56. In addition, an illumination part 59 is installed at the tip part 57. The illuminator 59 irradiates the subject with light and enables imaging. In addition, an intake / exhaust / supply / drain port 60 is provided at the distal end portion 57. The intake / exhaust / supply / drain port 60 is an opening for supplying gas or liquid to the tip portion 57. Further, the intake / exhaust / supply / drain port 60 is an opening for sucking a liquid or gas located in the subject. In addition, a multipurpose port 61 is provided at the distal end portion 57. The multipurpose port 61 is a part for installing various devices. For example, the nozzle 4 of the liquid ejecting apparatus 1 can be disposed at the multipurpose port 61.

  In addition, a hood 57 a is installed at the distal end portion 57. The hood 57a is formed of a transparent resin. When the distal end portion 57 is pressed against the tissue of the subject, the distance between the tissue of the subject and the objective lens 58 is not too close by the hood 57a. The hood 57a is transparent, and the endoscope 53 can also observe the outside of the hood 57a.

  An insertion port 62 is provided on the operation portion 54 on the insertion portion 56 side. The surgeon can insert the ejection tube 3 of the liquid ejection apparatus 1 from the insertion port 62. In the operation portion 54, a connection portion 63 is installed on the opposite side of the insertion portion 56. The connection part 63 is a part connected to a display device or a photographing device (not shown). Light entering from the objective lens 58 is output to the connection portion 63.

  A syringe, an electric knife, and a hemostatic device are used in steps before and after the treatment using the liquid ejecting apparatus 1. Next, a syringe, an electric knife, and a hemostatic device will be described. FIG. 5A is a schematic side sectional view showing the structure of an endoscope syringe. As shown in FIG. 5A, the syringe 64 includes a cylindrical body 65 and a pusher 66 that moves inside the cylindrical body 65. The cylinder 65 is also called a syringe, and the pusher 66 is also called a plunger. A flexible tube 67 is installed in the cylindrical body 65. An injection needle 68 is installed on the tube 67 on the opposite side of the cylinder 65. The cylinder 65, the tube 67 and the injection needle 68 are filled with the liquid 12. When the surgeon pushes the pusher 66 into the cylindrical body 65, the liquid 12 flows out from the injection needle 68.

  FIG. 5B is a schematic side sectional view showing the structure of the electric knife. As shown in FIG. 5B, the electric knife 71 as a cutting tool includes an operation unit 72. The operation unit 72 includes a first operation unit 72a and a second operation unit 72b. The first operation unit 72a and the second operation unit 72b are slidable in the left-right direction in the drawing and are movable. And the spring 73 is installed between the 1st operation part 72a and the 2nd operation part 72b. A wire 74 is installed in the first operation portion 72 a, and a knife 75 is installed at the tip of the wire 74. A cylindrical sheath 76 is installed in the second operation portion 72 b, and the wire 74 is disposed inside the sheath 76. A connecting portion 77 for guiding the wire 74 is installed at the end of the sheath 76 on the knife 75 side. A high frequency power source 78 is connected to the wire 74. The operation unit 72 and the sheath 76 are made of an insulating material, for example, a resin material. The wire 74, the connecting portion 77, and the knife 75 are made of a conductive metal material.

  When the knife 75 touches the subject, the electric knife 71 applies a high-frequency current to the subject. At this time, Joule heat is generated by the contact resistance between the subject and the knife 75. This heat instantly heats the cells, evaporates the water and solidifies the protein. Thereby, a cell can be cut | disconnected. In addition, fine blood vessels can be stopped.

  When the knife 75 protrudes from the connecting portion 77, it can be cut finely. When the knife 75 is integrated with the connecting portion 77, it can be cut roughly quickly. The surgeon operates the operation unit 72 to perform cutting according to the situation.

  FIG. 5C is a schematic side sectional view showing the structure of the hemostatic forceps. As shown in FIG. 5B, the hemostatic forceps 79 as a hemostatic device includes an operation unit 80. The operation unit 80 includes a first operation unit 80a and a second operation unit 80b. The first operation unit 80 a and the second operation unit 80 b are rotatable about the shaft 81. A cylindrical forceps sheath 82 is installed in the first operation portion 80a, and a fixed cup 83 is installed at the tip of the forceps sheath 82. A wire 84 is installed in the second operation portion 80 b, and the wire 84 is disposed inside the forceps sheath 82. The tip of the wire 84 is connected to the movable cup 85. The movable cup 85 is rotatable about a shaft 85a. When the operator operates the operation unit 80, the movable cup 85 rotates in synchronization with the movement of the operation unit 80. As a result, the fixed cup 83 and the movable cup 85 are opened and closed.

  A high frequency power source 86 is connected to the wire 84. The operation unit 80 and the forceps sheath 82 are made of an insulating material, for example, a resin material. The wire 84, the fixed cup 83, and the movable cup 85 are made of a conductive metal material.

  The fixed cup 83 and the movable cup 85 flow a high-frequency current across the blood vessel of the subject. At this time, Joule heat is generated by contact resistance between the blood vessel and the fixed cup 83 and the movable cup 85. This heat instantly heats the cells, evaporates the water and solidifies the protein. Thereby, the blood vessel is blocked and bleeding from the blood vessel can be stopped.

  Next, a cell tissue separation method for removing a tumor or the like using the liquid ejecting apparatus 1 described above will be described with reference to FIGS. FIG. 6 is a flowchart showing a cell tissue separation method. 7 to 9 are schematic diagrams for explaining the cell tissue separation method. The location and type of the tumor are not particularly limited, but in this embodiment, for example, an example of removing an esophageal tumor is shown.

  In the flowchart of FIG. 6, step S1 corresponds to an endoscope insertion step, which is a step of inserting the endoscope 53 into the body through the mouth and causing the distal end of the endoscope 53 to approach the tumor. Next, the process proceeds to step S2. Step S2 corresponds to a first liquid injection step. This step is a step of injecting the first liquid into the submucosal layer between the muscle layer and the mucosal layer. Next, the process proceeds to step S3. Step S3 corresponds to a mucosal incision step. This step is a step of incising the mucosa surrounding the tumor. Next, the process proceeds to step S4. Step S4 corresponds to a liquid ejecting apparatus arranging step. This step is a step in which the nozzle 4 of the liquid ejecting apparatus 1 is moved to the incised location. Next, the process proceeds to step S5. Step S5 corresponds to a second liquid injection step. This step is a step of injecting the second liquid into the submucosal layer between the muscle layer and the mucosal layer. Next, the process proceeds to step S6. Step S6 corresponds to a submucosal layer peeling step. This step is a step of removing the tumor by peeling the muscle layer and the mucosal layer in the submucosal layer. The removal of the tumor is completed by the above steps.

  Next, the cell tissue separation method will be described in detail using FIGS. 7 to 9 in association with the steps shown in FIG. Fig.7 (a) is a figure corresponding to the endoscope insertion process of step S1. As shown in FIG. 7A, the digestive organ has a structure in which a muscle layer 87, a submucosal layer 88, and a mucosal layer 89 are laminated. A tumor 92 is formed in the mucosa layer 89 as an initial cell tissue. In step S1, the endoscope 53 is operated to insert the distal end portion 57 into the body. A flexible endoscope 53 is inserted into the body from the mouth when the affected part is the esophagus, stomach or the like, and from the anus when the affected part is the large intestine or small intestine or the like. An objective lens 58 connected to the imaging device is installed at the distal end portion 57 of the endoscope 53 so that the tumor 92 can be confirmed by an image from outside the body. The surgeon operates the endoscope 53 to bring the distal end portion 57 closer to the tumor 92.

  FIG. 7B is a diagram corresponding to the first liquid injection step of step S2. As shown in FIG. 7B, a syringe 64 is installed in the endoscope 53 in step S2. A first liquid 93 is placed in the syringe 64 in place of the liquid 12. Next, the injection needle 68 of the syringe 64 is inserted from the mucosal layer 89. Then, the injection needle 68 is inserted until the tip of the injection needle 68 reaches the muscle layer 87. The first liquid 93 is injected from the syringe 64 into the submucosal layer 88 between the muscle layer 87 and the mucosal layer 89. By the injection of the first liquid 93, the mucosa layer 89 is lifted. Between the muscle layer 87 and the mucosa layer 89, there are muscles 94 and blood vessels 95. A liquid reservoir 96 in which the first liquid 93 is accumulated is formed between the muscle layer 87 and the mucosa layer 89. As the first liquid 93, a sodium hyaluronate solution or physiological saline can be used. Thus, the first liquid 93 can reduce the stimulation given to the muscle layer 87.

  FIGS. 7C and 8A are diagrams corresponding to the mucosal incision step of step S3. As shown in FIGS. 7C and 8A, an electric knife 71 is installed on the endoscope 53 in step S3. Next, the knife 75 of the electric knife 71 is energized to incise the mucosa layer 89 surrounding the tumor 92. As a result, a groove 97 is provided in the mucous membrane layer 89 so as to surround the tumor 92. The submucosa 88 is exposed by the groove 97.

  FIG. 8B is a diagram corresponding to the liquid ejecting apparatus arranging step in step S4 and the second liquid injecting step in step S5. As shown in FIG. 8B, in step S4, the liquid ejecting apparatus 1 is installed in the multipurpose port 61 of the endoscope 53. Then, the ejection tube 3 is protruded to the extent that the tip of the ejection tube 3 can be visually recognized from the image reflected by the photographing apparatus.

  In step S <b> 5, the tip of the ejection tube 3 is inserted into the groove 97 and is inserted under the mucosal layer 89 that has been cut open. Then, the second liquid 98 is ejected from the nozzle 4 in a pulse shape. Saline can be used for the second liquid 98. As a result, the submucosal layer 88 swells, and at the same time, a part thereof peels off from the muscle layer 87, and the mucosal layer 89 is further lifted. Specifically, in the liquid storage part 96, the fibrous muscle 94, the blood vessel 95, etc. mainly remain, and the other parts that are easily crushed are cut off so as to be scraped off. Further, even in a place where there are many muscles 94 and blood vessels 95, the second liquid 98 sprayed at a high speed is injected between them, and the submucosa 88 swells.

  A gap between the muscle layer 87 and the mucous membrane layer 89 is widened, and the second liquid 98 can be ejected in a shape that is nearly parallel to the muscle layer 87 and the mucosal layer 89. Thereby, the possibility that the endoscope 53 may be erroneously operated to damage the muscle layer 87 can be reduced. Further, since the gap between the muscle layer 87 and the mucous membrane layer 89 is widened, the operation of injecting and injecting the second liquid 98 can be facilitated.

  In this step, the endoscope 53 is inserted under the cut mucosa layer 89 and the endoscope 53 is inserted between the mucosa layer 89 and the muscle layer 87. Then, the endoscope 53 is pressed against the submucosal layer 88 and the mucosal layer 89. At this time, since the distance between the objective lens 58 and the tissue can be secured by the hood 57a, even if the distal end portion 57 of the endoscope 53 is pressed against the tissue, it is confirmed by seeing an image in which the distal end of the ejection tube 3 is projected. can do. The distal end portion 57 can apply stress to the submucosal layer 88. Therefore, even if the submucosal layer 88 is flexible, a part of the mucosal layer 89 can be easily separated from the muscle layer 87 in the submucosal layer 88 without causing the second liquid 98 to be jetted strongly, and the mucosal layer 89 can be levitated. . Thereby, the possibility that the endoscope 53 may be erroneously operated to damage the muscle layer 87 can be reduced.

  Further, the second liquid 98 is ejected in a pulse shape, and the strength of the ejection can be changed by controlling the pulsating flow. Thereby, incision can be performed with a smaller flow rate of the second liquid 98 than in the conventional method in which the second liquid 98 is continuously ejected. For this reason, it can avoid that the 2nd liquid 98 which injected the limited visual field of the imaging device like the endoscope 53 obstructs a visual field. Further, the cords other than the blood vessel 95 may be separated by the liquid ejecting apparatus 1 by adjusting the strength of the pulsating flow. Thereby, treatment time can be shortened efficiently, without exchanging a device.

  FIG.8 (c)-FIG.9 (b) are figures corresponding to the submucosa peeling process of step S6. As shown in FIG. 8C, an electric knife 71 is installed on the endoscope 53 in step S6. Then, the submucosal layer 88 between the mucous membrane layer 89 and the muscular layer 87 which has been injected by the second liquid 98 and spread by swelling and peeling is incised by the electric knife 71 and cut off. At this time, since the electric knife 71 can be inserted in a shape almost parallel to the muscular layer 87 and the mucosal layer 89, the possibility of damaging the muscular layer 87 by an operator's erroneous operation is low. Further, since the mucous membrane layer 89 and the muscle layer 87 are separated, the treatment can be easily performed in a short time.

  As shown in FIG. 9A, since the second liquid 98 is ejected in step S5, the blood vessel 95 is easily preserved. When bleeding from the blood vessel 95, the image observed through the endoscope 53 has poor visibility and treatment becomes difficult. However, the blood vessel 95 remaining between the mucosa layer 89 and the muscle layer 87 is easy to identify. At this time, the hemostatic forceps 79 is placed on the endoscope 53. Then, the blood vessel 95 remaining between the mucosa layer 89 and the muscle layer 87 is stopped using the hemostatic forceps 79. The surgeon can easily stop hemostasis by flowing a high-frequency current across the blood vessel 95 between the fixed cup 83 and the movable cup 85. The liquid reservoir 96 is easy to perform hemostasis because the hemostatic forceps 79 can easily enter. Thereby, since the field of view is not hindered by blood, the muscle 94 remaining between the mucosa layer 89 and the muscle layer 87 can be cut safely and efficiently.

  While repeating step S5 and step S6, finally, the mucosal layer 89 including the tumor 92 in the submucosal layer 88 can be peeled off from the muscle layer 87 as shown in FIG. 9B. The removal of the tumor 92 is completed by the above steps.

As described above, this embodiment has the following effects.
(1) According to this embodiment, in the digestive system organ, the submucosa 88 and the mucosa layer 89 are laminated on the muscle layer 87, and the tumor 92 is located in the mucosa layer 89. Then, the first liquid 93 is injected into the submucosa 88 between the mucosa layer 89 and the muscle layer 87. As a result, the mucosa layer 89 protrudes from the muscle layer 87. Then, the mucosa layer 89 around the tumor 92 is incised. Since the mucosal layer 89 protrudes with respect to the muscle layer 87, it can be easily incised.

  (2) According to this embodiment, the second liquid 98 is injected and injected into the submucosa 88 between the mucosa layer 89 and the muscle layer 87. As a result, the second liquid 98 is stored in the submucosa 88 between the mucosa layer 89 and the muscle layer 87 and the submucosa 88 is swollen, and at the same time, a part of the mucosa layer 89 is detached from the muscle layer 87 in the submucosa 88. The mucous membrane layer 89 is levitated. Then, the electric scalpel 71 separates the mucosal layer 89 and the muscle layer 87 that have floated in the submucosal layer 88. At this time, since the electric knife 71 can be inserted in a shape almost parallel to the muscular layer 87 and the mucosal layer 89, the muscular layer 87 and the mucosal layer 89 can be easily separated in the lower mucosa layer 88. Therefore, damage to the muscle layer 87 can be suppressed. Moreover, it can peel easily in a short time compared with the case where the submucosa 88 between the muscle layer 87 and the mucosa layer 89 is narrow. As a result, the tumor 92 can be disconnected safely and efficiently.

  (3) According to the present embodiment, when the mucosal layer 89 and the muscle layer 87 are separated in the submucosal layer 88, the blood vessel 95 remaining between the mucosal layer 89 and the muscle layer 87 is used with the hemostatic forceps 79. To stop bleeding. Therefore, since the visibility is not hindered by blood, the tumor 92 can be separated safely and efficiently.

  (4) According to the present embodiment, stress is applied in the direction in which the mucosal layer 89 is peeled from the muscle layer 87 in the submucosal layer 88. As a result, even if the submucosal layer 88 is flexible, the mucosal layer 89 and the muscle layer 87 are easily separated in the submucosal layer 88 without strongly spraying the second liquid 98 and the mucosal layer 89 is floated. be able to. Therefore, damage to the muscle layer 87 can be suppressed.

(Second Embodiment)
Next, an embodiment of a method for separating a cell tissue will be described using a schematic side sectional view for explaining a method for separating a cell tissue in FIG. This embodiment is different from the first embodiment in that the injection method of the first liquid 93 is different. Note that description of the same points as in the first embodiment is omitted.

  That is, in the present embodiment, as shown in FIG. 10, the liquid ejecting apparatus 1 is installed in the endoscope 53 in the first liquid injection process in step S <b> 2. Then, the first liquid 93 is injected using the liquid ejecting apparatus 1. In this case, the nozzle 4 is projected beyond the hood 57a. Injecting can be effectively performed by causing the nozzle 4 to protrude and touching the nozzle 4 against the mucous membrane layer 89. At this time, the nozzle 4 is in contact with the mucous membrane layer 89. The first liquid 93 immediately after being ejected from the nozzle 4 becomes a thin liquid having the same size as the nozzle 4. For this reason, even if the first liquid 93 having a strong pressure is not ejected, the first liquid 93 diffuses inside after penetrating the mucous membrane layer 89 like a needle. Thereby, the first liquid 93 is injected and the mucosa layer 89 is easily floated. Therefore, even if the first liquid 93 is ejected toward the muscle layer 87, it is possible to prevent the muscle layer 87 from being inadvertently damaged.

As described above, this embodiment has the following effects.
(1) According to the present embodiment, the first liquid 93 and the second liquid 98 are injected and injected by the liquid injection device 1. Therefore, the same liquid ejecting apparatus 1 can be used as the apparatus for injecting the first liquid 93 and the apparatus for injecting the second liquid 98. As a result, preparations for separating the tumor 92 can be facilitated.

  (2) According to the present embodiment, the first liquid 93 is ejected in a state where the nozzle 4 is in contact with the mucous membrane layer 89. At this time, the first liquid 93 immediately after being ejected from the nozzle 4 has a high flow velocity and is thin. Accordingly, diffusion of the first liquid 93 on the surface of the mucosal layer 89 is suppressed, and the first liquid 93 can penetrate the mucosal layer 89. Thereafter, the first liquid 93 diffuses in the submucosa 88. As a result, the first liquid 93 can be reliably injected to prevent the muscle layer 87 from being damaged.

(Third embodiment)
Next, an embodiment of a method for separating a cell tissue will be described using a schematic side sectional view for explaining a method for separating a cell tissue in FIG. This embodiment is different from the first embodiment in that the medicine is mixed in the second liquid 98. Note that description of the same points as in the first embodiment is omitted.

  That is, in the present embodiment, as shown in FIG. 11, the liquid ejecting apparatus 1 is installed in the endoscope 53 in the second liquid injection process in step S <b> 5. Then, the second liquid 99 is ejected from the nozzle 4 toward the liquid storage unit 96. The second liquid 99 is mixed with a medicine having hemostatic ability in physiological saline. As a result, microbleeding from a blood vessel 95 having such a small diameter that does not require coagulation hemostasis can be reduced, and the total amount of bleeding accompanying the operation of peeling the mucosal layer 89 from the muscle layer 87 in the submucosal layer 88 can be reduced. Furthermore, a good visual field (operating field) during the operation of peeling the mucosal layer 89 from the muscle layer 87 in the submucosal layer 88 can be secured. In addition, wound healing, an anticancer agent, etc. can be used for a chemical | medical agent.

As described above, this embodiment has the following effects.
(1) According to this embodiment, the 2nd liquid 99 contains the chemical | medical agent. Therefore, the effect of the drug can be exerted at the place where the mucosa layer 89 and the muscle layer 87 are separated in the submucosa 88. When the drug has hemostatic ability, microhemorrhage from small blood vessels can be reduced. When the drug has wound healing efficacy, it can reduce early healing of ulcers and post bleeding. When the drug is an anticancer drug, the local recurrence rate of cancer can be reduced.

(Fourth embodiment)
Next, an embodiment of a method for separating a cell tissue will be described using a schematic side sectional view for explaining a method for separating a cell tissue in FIG. This embodiment is different from the first embodiment in that a liquid containing a drug is sprayed and applied to the residue of the muscle layer 87 and the submucosa 88 after the tumor 92 is removed. Note that description of the same points as in the first embodiment is omitted.

  That is, in this embodiment, as shown in FIG. 12, the endoscope 53 is separated after the mucosal layer 89 and the muscle layer 87 are separated in the submucosal layer 88 and the mucosal layer 89 is removed in the submucosal layer peeling process in step S6. The liquid ejecting apparatus 1 is installed in the front. Then, the liquid 100 is ejected from the nozzle 4 toward the residue of the muscle layer 87 and the submucosal layer 88. And the liquid 100 containing a chemical | medical agent is apply | coated to the residue of the muscle layer 87 and the mucous membrane lower layer 88. FIG. Thereby, in the submucosa 88, the effect of the drug can be exerted on the residue of the muscle layer 87 and the submucosa 88 in the place where the mucosa layer 89 and the muscle layer 87 are separated.

  A hemostatic agent, wound healing, an anticancer agent, etc. can be used for a chemical | medical agent. For example, by injecting bFGF (basic fibroblast growth factor) or the like to promote wound healing, early healing of ulcers due to submucosal dissection and reduction of post-bleeding can be achieved. Also, by injecting steroid, prevention of esophageal stenosis, avoidance of endoscopic balloon dilation, and expansion of endoscopic treatment (healing without esophageal incision / chemoradiotherapy) can be achieved. Moreover, a local recurrence rate can be reduced by injecting an anticancer agent.

As described above, this embodiment has the following effects.
(1) According to the present embodiment, the liquid 100 containing the medicine is sprayed and applied to the place where the mucosa layer 89 and the muscle layer 87 are separated in the submucosa 88. Accordingly, the effect of the drug can be exerted on the submucosal layer 88 where the mucosal layer 89 and the muscle layer 87 are separated.

Note that the present embodiment is not limited to the above-described embodiment, and various changes and improvements can be added by those having ordinary knowledge in the art within the technical idea of the present invention. A modification will be described below.
(Modification 1)
In the first embodiment, hemostasis is performed using the hemostatic forceps 79. The hemostatic method is not limited to this, and a method of sandwiching the blood vessel 95 with a hemostatic clip as a hemostatic device may be used. The electric knife 71 and hemostatic forceps 79 are energized with a monopole type high frequency current, but may be a bipolar type.

(Modification 2)
In the first embodiment, the first liquid 93 is injected in the first liquid injection process of step S2. The first liquid 93 may be a gel.

(Modification 3)
In the first embodiment, the endoscope 53 is pressed against the submucosal layer 88 and the mucosal layer 89 in the second liquid injection process of step S5. When the second liquid 98 can be injected with good workability without being pressed against the submucosa 88 and the mucosa layer 89, the operator does not need to press the endoscope 53 against the submucosa 88 and the mucosa layer 89.

  The treatment target in the first embodiment may be an entire animal including a person or may be limited to an animal excluding a person.

  DESCRIPTION OF SYMBOLS 4 ... Nozzle, 53 ... Endoscope, 71 ... Electric knife as a cutting tool, 79 ... Hemostatic forceps as a hemostatic device, 87 ... Muscle layer, 88 ... Submucosal layer, 89 ... Mucosal layer, 92 ... As cell tissue Tumor, 93 ... first fluid, 95 ... blood vessel, 98,99 ... second fluid.

Claims (7)

A cell tissue separation method in which a submucosal layer and a mucosal layer are laminated on a muscle layer, and the cell tissue in the mucosal layer is separated,
Injecting a first liquid into the submucosa between the mucosa layer and the muscle layer;
Incising the mucosa layer surrounding the cellular tissue,
Injecting and injecting a second liquid into the submucosa between the mucosa layer and the muscle layer;
A method for detaching a cell tissue, comprising severing the mucosa layer and the muscle layer with a severing tool in the submucosa layer where the second liquid is injected. The cell tissue separation method according to claim 1,
When the mucosal layer and the muscle layer in the submucosal layer are cut off with the cutting tool,
A cell tissue separation method comprising hemostasis of a blood vessel remaining between the mucosa layer and the muscle layer using a hemostasis device. The cell tissue separation method according to claim 1 or 2,
When injecting the second liquid, an endoscope is inserted between the mucosa layer and the muscle layer,
A method for separating a cell tissue, comprising pressing the submucosal layer with the endoscope. The cell tissue separation method according to any one of claims 1 to 3,
When injecting said 1st liquid, the said 1st liquid is injected and inject | poured, The cell tissue cutting method characterized by the above-mentioned. The cell tissue separation method according to claim 4,
A method for separating a cell tissue, wherein the first liquid is ejected from a nozzle, and the first liquid is ejected by contacting the nozzle with the mucosal layer. A cell tissue separation method according to any one of claims 1 to 5,
The cell tissue separation method, wherein the second liquid contains a drug. A cell tissue separation method according to any one of claims 1 to 6,
A method for detaching a cellular tissue, comprising separating the mucosa layer and the muscle layer in the submucosa layer and then spraying and applying a liquid containing a drug to the remaining muscle layer.

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