JP2018187213A - Laser chip, laser treatment instrument, laser treatment apparatus, and laser treatment system - Google Patents

Abstract

In view of the above-described problems, the present invention provides a laser chip, a laser treatment apparatus, and a laser treatment system that can safely perform treatment in laser medicine and can stop bleeding even when bleeding occurs. Objective. A laser chip includes a laser transmission path mounting portion that is detachably attached to a laser irradiation port so that the laser chip is mounted to a laser irradiation port that irradiates a laser beam. 71, an abutting portion 72 that abuts on the living tissue, and an abutment space S arranged in front of the laser transmission path mounting portion 71 in the irradiation direction of the laser light 57a emitted from the laser irradiation port 63a. A connecting portion 73 that connects a part of the portion 72 and the laser transmission path mounting portion 71 is connected, and a laser beam 57a that is irradiated forward from the laser irradiation port 63a is connected to the rear of the contact portion 72. A reflection surface 72 b that reflects toward the portion 73 is provided. [Selection] Figure 3

Description

  The present invention relates to, for example, a laser chip attached to the tip of a laser transmission path, a laser treatment tool attached with the laser chip, a laser treatment apparatus, and a laser treatment system.

  In recent years, in the fields of laparotomy and dental treatment, there are cases where treatment is performed using an electric knife or a laser treatment device using laser light, and development of minimally invasive medical treatment using these treatment devices is progressing. . For example, surgical or medical treatment using an endoscope is performed as minimally invasive medical treatment. In particular, endoscopic submucosal dissection (abbreviated as ESD) for early gastrointestinal cancer is drawing attention as an effective treatment method with less burden on patients.

  For example, in the ESD described above, first, the periphery of the affected area to be treated is marked, and the mucosa layer is incised using this as a mark. Next, the tissue of the submucosa is peeled off, and the entire tissue of the tumor part is removed. In these treatments for marking, mucosal incision, and submucosal detachment, a high-frequency electric knife is generally used as a treatment tool. However, blood vessels may also exist in the submucosal layer, which may cause bleeding during the treatment. In addition, for the treatment of a particularly thin tissue wall such as the large intestine, an advanced practitioner is required for an ESD practitioner to perforate the muscle layer outside the submucosa and cause complications.

  As a treatment tool that replaces the high-frequency electric knife, a treatment method using a laser beam effective for incision, hemostasis, coagulation, and transpiration of a living tissue has been developed. Carbon dioxide laser light, in particular, has a very high absorption rate for living tissue and water, so that laser light does not penetrate deep into the tissue and damages normal tissue in the deep part. Therefore, compared with the conventional treatment method using a high-frequency electric knife, it is possible to perform treatment in a minute region while suppressing excessive thermal damage.

  Under such circumstances, development of laser medical equipment that enables all treatments including hemostasis with laser alone without changing the energy source during the treatment is being promoted, and various laser chips attached to the laser irradiation port Has been proposed. For example, Patent Document 1 discloses a plurality of laser chips provided with a tip portion that absorbs laser light applied to the tip of a laser irradiation port.

  These laser chips are formed in various shapes such as a tapered shape, a flat shape at the tip, and a curved shape at the tip, and a chip having an appropriate shape can be selected according to the purpose such as incision and hemostasis. Can do. Specifically, it is said that blood can be coagulated and hemostasis can be achieved by bringing the laser chip heated by irradiating the laser chip with laser light into contact with the periphery of the target incision site.

  However, even though the tip of the laser chip disclosed in Patent Document 1 absorbs the laser light emitted from the laser irradiation port, a part of the incident laser light is reflected by the tip, There was a risk of unexpectedly irradiating normal tissues that were not treated.

JP-A-6-205789

  Therefore, in view of the above-described problems, the present invention has an object to provide a laser chip, a laser treatment apparatus, and a laser treatment system that can safely perform treatment in laser medicine and can stop bleeding even when bleeding occurs. To do.

The present invention provides a laser chip attached to a laser irradiation port for irradiating a laser beam provided at the tip of a laser transmission path, wherein the laser chip is attached to the laser irradiation port and attachable to and removable from the laser irradiation port. And a connecting part that is disposed with an open space in front of the laser light irradiation direction irradiated from the laser irradiation port with respect to the mounting part, and connects the contact part and the mounting part. And a reflection part configured to reflect the laser light emitted toward the front from the laser irradiation port toward the connection part.
In addition, the present invention is a laser treatment instrument provided with a laser transmission path for guiding laser light to a treatment target site and the above-described laser chip.

  Further, the present invention is a laser treatment apparatus including a laser oscillator that oscillates a carbon dioxide laser beam, a laser transmission path that guides the laser beam oscillated from the laser oscillator to a site to be treated, and the laser chip described above. It is characterized by.

Furthermore, the present invention is a laser treatment system comprising the above-described laser treatment apparatus and an endoscope that can be inserted through the laser transmission path.
The laser medical treatment is not limited to a specific laser treatment, and laser treatment using a flexible endoscope such as ESD, surgical treatment using a rigid endoscope, or laser treatment such as laparotomy or dental treatment. Including.

  With respect to the above-mentioned mounting part, it is arranged between the mounting part and the abutting part that is arranged with an open space in front of the irradiation direction of the laser light emitted from the laser irradiation port. Instead of connecting so as to close the space, it means connecting the mounting part and the contact part so as to form an open space opened to the outside in the orthogonal direction.

  The reflection unit may have any configuration as long as the laser beam can be reflected toward the coupling unit. For example, the laser beam refracted using a planar or concave reflection unit, a combination of a plurality of reflection units, a prism, or the like. The structure etc. which reflect light toward the said connection part are included.

According to the present invention, in laser medicine, it is possible to safely perform a procedure and to stop bleeding even when bleeding occurs.
More specifically, since the reflection part reflects the laser light emitted from the laser irradiation port toward the connection part, the reflected laser light is emitted to a normal tissue that is not a treatment target. Can be prevented, and damage to normal living tissue can be prevented.

  Further, when the laser beam is irradiated on the contact portion, the contact portion absorbs the energy of the laser light and is heated. By bringing the contact portion thus heated into contact with, for example, a bleeding damaged site, the damaged site can be stopped.

  Furthermore, the connection part is configured to connect a part of the contact part and the mounting part, so that the contact part and the mounting part are opened with respect to the orthogonal direction. The open space is formed. As a result, a fibrotic tissue that is difficult to cut can be held in the open space and irradiated with the laser light, and the tissue can be cut reliably.

  In addition, by providing the abutting portion capable of absorbing the laser light in front of the laser irradiation port, it is possible to provide a so-called backstop function that prevents the laser light from being irradiated forward, in particular. Even when the periphery of a tissue having a thin tissue wall is peeled off, the treatment can be performed without risk of perforating normal tissue.

As described above, the present invention can stop bleeding sites and prevent normal tissue from being damaged or perforated by the laser light by being irradiated with the reflected light of the laser light. Can be performed safely.
The laser beam is not necessarily a carbon dioxide laser, and the present invention can be used for laser treatment using other laser beams.

As an aspect of the present invention, the reflection portion may be formed of a reflection surface that forms an acute angle with respect to the connection portion.
Forming an acute angle with respect to the above-mentioned connecting part means that the reflecting surface and the connecting part form an acute angle, and the connecting part between the reflecting part and the connecting part provided with the reflecting surface is It does not necessarily have to be an acute angle. That is, if the reflecting surface and the connecting portion are formed at an acute angle, the connecting portion between the reflecting portion and the connecting portion may be formed at an acute angle, or may be formed in an arc shape. Including.

  According to the present invention, the laser beam reflected by the reflecting surface can be reliably reflected by the connecting portion, and the reflected light can be prevented from being unexpectedly irradiated to a normal tissue that is not a treatment target. Moreover, since this reflected light is irradiated to the connection part side holding a laser light absorption part, it contributes to heating a laser chip and can utilize laser energy efficiently.

  Further, since the reflecting surface and the connecting portion are formed at an acute angle, when the living tissue is held so as to be disposed in the open space, the reflecting surface and the connecting portion form a depression formed by the reflecting surface and the connecting portion. Can be hooked. Thereby, since the said biological tissue can be hold | maintained reliably, the said laser beam can be irradiated stably and reliably, and the said biological tissue can be cut | disconnected. Furthermore, since thin blood vessels can be cut reliably, irradiation with laser light while moving the distal end of the treatment instrument laterally or forward is easy even in tissues that are difficult to cut, such as fibrotic tissues. Incision and detachment are possible. Further, by moving the distal end of the treatment tool toward the front while holding the target tissue, it is possible to secure a distance from the muscle layer that should not be perforated, so that a more delicate procedure is possible and safety is high.

As an aspect of the present invention, a contact surface formed with a curved surface having a curvature radius of 10 mm or more or a flat surface may be provided in front of the contact portion.
Specifically, the above-mentioned curved surface refers to a convex curved surface protruding toward the tip side or a curved surface that is concave toward the laser irradiation port side.

According to the present invention, hemostasis can be surely performed without expanding the damaged area.
More specifically, for example, when the radius of curvature of the abutment portion is +10 mm or more, or when the abutment portion is flat, that is, when the abutment portion is formed of a convex curved surface, or the abutment When the part is flat, the abutting part can be directly pressed against the damaged part to irradiate the abutting part with laser light. This absorbs the energy of the laser beam and coagulates the damaged part where the contact part heated is in contact with the blood around it, thereby reliably stopping the damaged part.

On the other hand, when the radius of curvature of the abutting portion is −10 mm or more, that is, when the abutting portion is formed of a concave curved surface, the abutting portion is pressed against the damaged site from the damaged site. The blood that has come out can be stored in the concave portion, and the blood stored in the concave portion can be coagulated by the contact portion heated by irradiating the laser beam to stop the damaged site.
As described above, since the hemostasis using the abutting portions having different curvature radii has different haemostatic effects, the abutting portions having curved surfaces or flat surfaces having different curvature radii depending on the bleeding site and the bleeding situation are selectively used. be able to.

As an aspect of the present invention, the connecting portion is provided with a protruding portion that protrudes toward the optical axis of the laser light emitted from the laser irradiation port and has a convex cross-sectional shape as viewed from the optical axis. May be.
According to the present invention, it is possible to reliably irradiate the living tissue held by the contact portion and the connecting portion so as to be positioned in the open space.

More specifically, when the projecting portion is not provided, even if the living tissue is held by the contact portion and the connecting portion so as to be located in the open space, a position where the laser beam is irradiated is predetermined. It was difficult to adjust the position. However, the living tissue can be arranged in the protruding portion or the protruding portion in the open space by providing the protruding portion protruding toward the optical axis of the laser beam.
Thereby, the said laser beam can be irradiated to the predetermined position of the said biological tissue, and the said biological tissue can be cut | disconnected in a desired position.

As an aspect of the present invention, the cross-sectional shape of the protrusion may be a triangular shape with an acute angle on the optical axis side.
According to this invention, since the protruding portion is formed in an acute angle shape, the protruding portion can assist in cutting the living tissue held in the open space.

As an aspect of the present invention, the reflecting portion may be provided with a coating whose surface reduces the reflection of the laser light.
According to the present invention, since the energy of the laser beam absorbed by the contact portion can be increased, the contact portion can be efficiently heated. Thereby, when the said contact part is made to contact | abut to the damaged site | part bleeding in the biological tissue, it can stop hemostasis reliably.

As an aspect of the present invention, the contact portion may be provided with an anti-adhesion coating that prevents the contact with the living tissue.
The anti-adhesion coating may be any coating as long as it does not adhere to a living tissue. For example, titanium carbide (TiC), titanium nitride (TiN), silicon carbide (SiC), silicon nitride, nitriding Boron (BN) and the like are included.

  According to the present invention, since the abutting portion brought into contact with the living tissue can be prevented from adhering to the living tissue, when the contacting portion is separated from the damaged site where hemostasis is stopped, Damage can be prevented.

  According to the present invention, it is possible to provide a laser chip, a laser treatment apparatus, and a laser treatment system that can safely perform treatment in laser medicine and can stop bleeding even when bleeding occurs.

The schematic block diagram of the treatment system by an endoscope apparatus and a laser treatment apparatus. The block diagram which shows the structure of an endoscope apparatus and a laser treatment apparatus. The schematic perspective view of the laser chip with which the front-end | tip of the hollow waveguide was mounted | worn. FIG. 2 is a schematic exploded perspective view of a tip of a hollow waveguide and a laser chip. Explanatory drawing of the laser chip with which the hollow waveguide was mounted | worn. Explanatory drawing of the hemostasis using a treatment system. Explanatory drawing of cutting | disconnecting a biological tissue using a laser chip. Explanatory drawing of another embodiment of a laser chip. Explanatory drawing of another embodiment of a laser chip.

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

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

The operation unit 13 includes an eyepiece unit 15, a vertical angle knob 16, a left / right angle knob 17, an operation button 18, a device insertion port 20, and the like.
The operation button 18 receives operation inputs such as air supply, water supply, suction, and zoom.

  The endoscope tube 21 is provided with a flexible tube portion 22, a curved tube portion 23, and a distal end configuration portion 30 in this order from the base portion toward the distal end. A device insertion path 19 that communicates from the device insertion port 20 to the device outlet 36 of the distal end component 30 is provided inside the endoscope tube 21. The device insertion path 19 functions as a therapeutic device insertion path for inserting a therapeutic device such as forceps or a laser transmission path 60.

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

The flexible tube portion 22 has a cylindrical shape that is appropriately curved, and allows a therapeutic device such as an appropriate forceps to be inserted from the device insertion port 20 to the distal end configuration portion 30. In this embodiment, a laser transmission path 60 in which a laser chip 70 of a laser treatment apparatus 50 is assembled at the tip is inserted as a treatment device.
The bending tube portion 23 is bent in the vertical direction by the operation of the vertical angle knob 16 and is bent in the horizontal direction by the left and right angle knob 17.

The distal end configuration unit 30 is provided with light guides 31 and 35, a sub-water supply port 32, a lens 33, a nozzle 34, and a device outlet 36.
The light guides 31 and 35 are illumination parts that irradiate light serving as illumination for imaging. This makes it possible to observe and perform treatment by illuminating the inside of the body where light does not reach.

The auxiliary water supply port 32 is a water supply port that discharges a liquid such as a staining solution.
The lens 33 is a lens for collecting light from illumination such as the light guides 31 and 35 and acquiring a captured image, and an image sensor disposed behind the lens.

The nozzle 34 is a part that discharges a cleaning liquid or the like for cleaning the lens 33 toward the lens 33.
The device outlet 36 is an outlet of a treatment device such as the laser transmission path 60 of the laser treatment apparatus 50. The laser transmission path 60 is formed longer than the device insertion path length which is also the entire length of the endoscope tube 21. Details of the laser transmission path 60 will be described later.

As shown in FIG. 2, the laser treatment apparatus 50 includes an operation unit / display unit 51, a power supply unit 52, a central control unit 54, a guide light emitting unit 56, and a laser oscillation unit 57.
The operation unit / display unit 51 receives an operation input such as a laser output setting or an operation mode change and transmits an input signal to the central control unit 54, and the laser output condition, the operation status of the apparatus, etc. from the central control unit 54 The display signal is received and appropriate information is displayed.
The power supply unit 52 supplies operating power to each unit such as the central control unit 54.

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

  The guide light emitting unit 56 emits guide light for indicating a position where the therapeutic laser light 57a is irradiated. This guide light can confirm the position where the therapeutic laser beam 57a is irradiated.

The laser oscillation unit 57 oscillates a laser beam 57a used for the treatment. In this embodiment, a carbon dioxide laser is used as the laser beam 57a. Operations such as setting of the irradiation intensity of the carbon dioxide laser and starting and stopping of irradiation are performed by manual operation by the operation unit / display unit 51 and control output by the central control unit 54. Note that part or all of the manual operation can be replaced with a stepping operation using a foot controller (not shown) provided to be able to communicate and control the laser treatment apparatus 50.
The guide light 56 a irradiated by the guide light emitting unit 56 and the laser light 57 a oscillated by the laser oscillation unit 57 are all transmitted through one laser transmission path 60.

The endoscope apparatus 10 includes an operation unit 41, a power supply unit 42, a central control unit 43, an illumination unit 44, an imaging unit 45, a water ejection unit 46, and an image display unit 47.
The operation unit 41 transmits an operation input by the operation unit 13 (see FIG. 1) to the central control unit 43. That is, the bending operation of the bending tube portion 23 by the operation of the vertical angle knob 16 and the left and right angle knob 17, the pressing operation by the operation button 18, and the like are transmitted. Alternatively, separately from the operator operation unit 12, for example, an operation unit is provided in a controller main body (not shown) of the endoscope apparatus, and operations such as illumination light quantity and still image shooting and storage are performed by the central control unit. 43.

The power supply unit 42 supplies operating power to each unit such as the central control unit 43, and the central control unit 43 executes various control operations on each unit.
The illumination unit 44 performs illumination from the light guides 31 and 35 (see FIG. 1).

  The image capturing unit 45 captures an image transmitted from the lens 33 and an image sensor (see FIG. 1) disposed behind the lens 33, obtains a captured image necessary for the treatment, and performs image processing. By continuously acquiring the captured images in real time, the surgeon can perform the treatment smoothly.

  The water ejecting unit 46 ejects liquid from the auxiliary water supply port 32. In addition, liquid ejection from the nozzle 34 is also executed. As described above, the imaging unit 45 may be provided in the vicinity of the distal end configuration unit 30 or may be provided in a controller main body (not shown) of the endoscope apparatus 10.

  The image display unit 47 displays an image according to a signal transmitted from the central control unit 43. This image includes a captured image acquired by the imaging unit 45. Therefore, the surgeon can perform the procedure while confirming the captured image displayed on the image display unit 47 in real time.

Next, the structure of the laser transmission path 60 and the structure of the laser chip 70 attached to the tip of the laser transmission path 60 will be described with reference to FIGS.
3 is an enlarged perspective view of the tip of the laser transmission path 60, more specifically, a schematic perspective view of the laser chip 70 attached to the tip of the laser transmission path 60, and FIG. FIG. 5 is an explanatory view of the laser chip 70 attached to the laser transmission path 60. 3 and 4, a part of the laser tube 61 constituting the laser transmission path 60 is indicated by a dotted line to indicate a transmission state.

  5A is a side view of the laser transmission path 60 to which the laser chip 70 is mounted, and FIG. 5B is a cross-sectional view taken along the line AA in FIG. The longitudinal cross-sectional view in the state which removed the laser chip 70 from FIG. 5C is shown, FIG.5 (c) shows BB sectional drawing in Fig.5 (a).

  As shown in FIGS. 3 and 4, the laser transmission path 60 is inserted into the laser tube 61, the laser chip side mounting portion 62 provided at the tip of the laser tube 61, and the inside of the laser tube 61. The hollow waveguide 63 is formed longer than the endoscope tube 21 as described above.

  The laser tube 61 is a hollow and flexible resin tube having an insertion space 61a (see FIG. 5) through which the hollow waveguide 63 is inserted. As shown in FIG. 3 and FIG. The outer peripheral convex portion 61b having an outer diameter slightly smaller than the inner diameter of the device insertion path 19 of the endoscope tube 21 and an outer periphery that is more concave than the outer peripheral convex portion 61b between the adjacent outer peripheral convex portions 61b. The recesses 61c are arranged in parallel in the circumferential direction, and are formed in a substantially gear shape in a cross section viewed from the optical axis direction D corresponding to the irradiation direction of the laser light 57a.

  When the laser tube 61 configured in this manner is inserted into the device insertion path 19, the outer peripheral convex portion 61 b abuts against the device insertion path 19 and is firmly fixed, and according to the bending of the endoscope tube 21. Can be bent flexibly.

As shown in FIGS. 4 and 5A, the laser chip side mounting portion 62 has a configuration in which a transmission path side mounting portion 62a, a tube connecting portion 62b, and a laser chip mounting portion 62c are arranged side by side from the rear.
As shown in FIG. 5A, the transmission line side mounting portion 62a has an outer diameter substantially the same as the inner diameter of the laser tube 61 and an inner diameter that is slightly larger than the outer diameter of the hollow waveguide 63 described later. It is formed of a cylindrical body, can be inserted through the hollow waveguide 63, and the laser chip side mounting portion 62 can be fitted to the laser tube 61 by inserting the transmission path side mounting portion 62a into the insertion space 61a. .

  The tube connecting portion 62b is a cylindrical body provided at the tip of the transmission path side mounting portion 62a, has an outer diameter slightly smaller than the inner diameter of the device insertion path 19, and is substantially the same as the outer diameter of the hollow waveguide 63. In the state where the laser chip side mounting portion 62 is mounted on the laser tube 61 and has an inner diameter, the outer peripheral surface of the laser tube 61 and the laser chip side mounting portion 62 is flush with each other, and a laser described later. The irradiation port 63 a can be fixed to the central portion of the laser tube 61.

  The laser chip mounting portion 62c is a cylindrical body having an outer diameter substantially the same as the transmission path side mounting portion 62a provided so as to extend forward from the tip of the tube connecting portion 62b. Is provided with a thread 62d.

  The hollow waveguide 63 inserted into the insertion space 61a is a cylindrical body in which the entire inner surface of an internal hollow cylindrical cylindrical body is covered with a dielectric thin film (not shown), and the tip is irradiated with a laser beam 57a. A laser irradiation port 63a is provided.

The cylindrical body constituting the hollow waveguide 63 has a smooth surface such as a glass tube and is formed in a long shape by a material suitable for forming a reflective film such as silver and a dielectric thin film. (Cyclic olefin polymer), polyimide, or the like is formed of an appropriate material that efficiently reflects and transmits laser light.
Thus, since the inner peripheral surface of the hollow waveguide 63 is covered with a reflective film such as silver and a dielectric thin film, the laser light 57a that conducts the inside of the hollow waveguide 63 can be conducted with high transmission efficiency. it can.

  The laser chip 70 to be mounted on the laser transmission path 60 is a stainless-steel laser chip. As shown in FIGS. 3 to 5, the laser transmission path 60 can be attached to and detached from the laser transmission path 60, and the laser transmission path mounting section. 71 is formed integrally with a contact portion 72 disposed in front of the contact portion 71 with a predetermined interval, and a connecting portion 73 that connects the laser transmission path mounting portion 71 and the contact portion 72.

  The laser transmission path mounting portion 71 corresponding to the mounting portion is formed of a cylindrical body having an outer diameter substantially the same as the outer shape of the tube connecting portion 62b and having an inner diameter substantially the same as the inner diameter of the transmission path side mounting portion 62a described later. A thread groove 71a that can be screwed with the thread 62d is formed on the inner peripheral surface of the laser transmission path mounting portion 71 on the rear end side (see FIG. 5B).

  The abutting portion 72 provided at the tip of the laser chip 70 has an outer diameter substantially the same as the inner diameter of the laser chip mounting portion 62c, that is, a solid substantially cylindrical shape that is slightly smaller than the laser transmission path mounting portion 71. The front end is provided with a contact surface 72a that comes into contact with the living tissue, and the rear end side is provided with a reflection surface 72b that reflects the laser light 57a emitted from the laser irradiation port 63a (FIG. 6 ( a) see).

  The contact surface 72a is a circular plane along a cross section orthogonal to the optical axis direction D, and is formed so that the laser beam 57a is irradiated at the center. In addition, the surface is coated with titanium carbide (TiC) in order to prevent sticking to a living tissue.

  The reflecting surface 72b is a reflecting surface provided on the laser irradiation port 63a side of the abutting portion 72, and as shown in FIG. 5A, the optical axis is directed so as to face the connecting portion 73 described later. It is provided at an acute angle with respect to the direction D. The reflective surface 72b is coated with a coating member that reduces the reflection of the laser light 57a. In other words, the connecting portion 73 is coated with a coating member that absorbs the energy of the laser light 57a.

  As shown in FIGS. 3 to 5, the connecting portion 73 that connects the laser transmission path mounting portion 71 and the abutting portion 72 arranged at a predetermined interval is connected to the laser transmission path mounting portion 71 and the abutting portion 72. Are connected along the optical axis direction D. The angle θ formed by the connecting portion 73 and the reflecting surface 72b is designed to be 45 degrees.

  In the present embodiment, the angle formed by the connecting portion 73 and the reflection surface 72b is 45 degrees, but the angle is not necessarily limited to this, and any angle may be used as long as it is an acute angle.

  In addition, a protruding portion 74 that protrudes toward the optical axis formed by the laser beam 57a is formed on the inner upper surface of the connecting portion 73. As shown in FIG. 5C, the projecting portion 74 is configured to project in a triangular shape having an acute angle on the optical axis side in the cross section viewed from the optical axis direction D.

  The laser chip 70 configured as described above can be mounted on the laser transmission path 60 by screwing the laser transmission path mounting section 71 to the laser chip mounting section 62c. In this state, the laser treatment device 50 is operated to transmit the laser beam 57a, whereby the laser beam 57a can be irradiated to the contact portion 72.

  Hereinafter, with reference to FIG. 6 and FIG. 7, the case where the laser light 57 a is irradiated with the laser chip 70 mounted on the laser transmission path 60 and the hemostasis of the bleeding site E and the cutting of the living tissue using the laser chip 70 will be described. To do.

  6A is a side view showing the path of the laser light 57a irradiated in a state where the laser chip 70 is attached to the laser transmission path 60, and FIG. 6B shows the contact surface 72a on the bleeding site E. Explanatory drawing showing the state pressed against is shown.

  As shown in FIG. 6A, in a state where the laser chip 70 is mounted on the laser transmission path 60, the laser light 57a irradiated from the laser irradiation port 63a is reflected toward the connecting portion 73 by the reflecting surface 72b. .

  Here, since the reflecting surface 72b is coated with a coating member that absorbs the energy of the laser beam 57a, the contact portion 72 that has been irradiated with the laser beam 57a is efficiently heated. As shown in FIG. 6B, the contact surface 72a heated in this manner can be contacted with the bleeding site E to coagulate blood B efficiently.

  Further, since the reflection surface 72b is coated with a coating member that absorbs the energy of the laser light 57a, the energy of the reflected light of the laser light 57a reflected to the connecting portion 73 is reduced. Even if the reflected light of the irradiated laser beam 57a is further reflected and diffused, normal living tissue is not damaged.

  Further, as shown in FIGS. 3 to 5, the connecting portion 73 is configured to connect a part of the laser transmission path mounting portion 71 and the abutting portion 72 with a predetermined interval therebetween. In the portion, the laser transmission path mounting portion 71 and the contact portion 72 are not connected, and an open space S communicating with the outside is formed.

A method of arranging and cutting a living tissue, specifically, a tissue of the submucosa L2 in the vicinity of the affected tissue T to be peeled in such an open space S will be briefly described with reference to FIG.
FIG. 7 is an explanatory view showing the cutting of the submucosa L2 using the laser chip 70. Specifically, FIG. 7A is a schematic perspective view showing the cutting of the submucosa L2 using the laser chip 70. FIG.7 (b) shows the schematic plan view of Fig.7 (a).

First, a mark (marking M) in a range to be cut out is applied by irradiating the mucous membrane layer L1 with a plurality of points of laser light 57a so as to surround the affected tissue T which is a peeled target. Next, hyaluronic acid H is injected into the lower mucosa L2 below the affected tissue T to bring the affected tissue T into a floating state, and laser light 57a is irradiated along the affected tissue T to cut the mucosal layer L1. Hereinafter, a line cut by irradiating the laser beam 57a is referred to as an incision line I.
At this time, the mucous membrane layer L1 is incised along the incision line I, but the inner side of the incision line I (affected tissue T side) is connected to the submucosa L2.

  Next, the laser transmission path 60 is removed from the device insertion slot 20, the laser chip 70 is attached to the tip of the laser transmission path 60, and the laser transmission path 60 is inserted into the device insertion slot 20 again. Then, as shown in FIGS. 7 (a) and 7 (b), the abutting portion 72 is inserted along the incised incision line I, and the submucosa L2 connected inside the incision line I by the connecting portion 73b. The tissue of the submucosa L2 is irradiated with the laser beam 57a in a state where tension is applied to the tissue of the submucosa L2. Thereby, the tissue of the submucosa L2 irradiated with the laser beam 57a is cut.

  Similarly, the laser chip 70 is moved so as to cut along the incision line I, the tissue of the submucosa L2 is pulled and pulled, and the laser light 57a is irradiated in a state where the tissue of the submucosa L2 is tensioned. Thus, by cutting the tissue of the submucosa L2 while moving the laser chip 70 along the incision line I, the affected tissue T can be cut from the surrounding submucosa L2, and the affected tissue T can be separated. .

  At this time, since the laser light 57a emitted from the laser irradiation port 63a is applied to the reflecting surface 72b, it does not irradiate the submucosa L2 and the muscle layer L3 and perforates the muscle layer L3. Can be prevented.

  Further, by providing the protrusion 74, the tissue of the submucosa L2 can be disposed at a position where the laser light 57a is irradiated, and the tissue of the submucosa L2 can be cut reliably. Moreover, since the optical axis side of the protrusion 74 is configured with an acute triangle, the tissue of the submucosa L2 to which tension is applied can be more easily cut.

Here, in the above-described example, the case where the contact surface 72a is a flat surface has been described. However, the contact surface is not necessarily a flat surface. For example, the contact surface may be a gently convex surface or a concave surface. .
Hereinafter, a laser chip 70x having a gentle convex surface and a laser chip 70y having a gentle concave surface will be described with reference to FIGS. Note that, among the configurations of the laser chips 70x and 70y described below, the same components as those of the laser chip 70 are denoted by the same reference numerals, and description thereof is omitted.

  FIG. 8 shows an explanatory diagram when the contact surface is a gentle convex surface, and FIG. 9 shows an explanatory diagram when the contact surface is a gentle concave surface. Specifically, FIG. 8A shows a cross-sectional view of a laser chip 70x having a gently convex contact surface, and FIG. 8B shows a schematic cross-sectional view of a hemostasis method for a bleeding site E using the laser chip 70x. Show. 9A shows a cross-sectional view of the laser chip 70y having a gently convex contact surface, and FIG. 9B shows a schematic cross-sectional view of a hemostasis method for the bleeding site E using the laser chip 70y. . The bleeding site E is a blood vessel that runs in the submucosa L2 between the mucosa layer L1 and the muscle layer L3.

  In the laser chip 70x, as shown in FIG. 8A, the contact surface formed in front of the laser chip 70x is configured by a gently curved contact convex surface 72x protruding forward and having a radius of curvature of 15 mm. Yes.

For this reason, when the contact convex surface 72x is brought into contact with the bleeding site E, the living tissue is deformed along the curved surface, and the amount of blood interposed between the bleeding site E and the contact convex surface 72x can be further reduced. The blood B can be surely coagulated to stop bleeding from the bleeding site E (see FIG. 8B).
Further, unlike the laser chip 70, the laser chip 70x does not have a corner formed at the end of the abutting convex surface 72x, so that it is possible to prevent damaging the living tissue near the bleeding site E at the corner.

  On the other hand, in the laser chip 70y, as shown in FIG. 9A, the contact surface formed in front of the laser chip 70y is configured by a gently curved contact concave surface 72y with a curvature radius of 15 mm recessed backward. Has been.

  For this reason, when the contact concave surface 72y is brought into contact with the bleeding site E, the blood B can be accumulated between the contact concave surface 72y and the bleeding site E. The accumulated blood B can be reliably coagulated by contacting the heated contact concave surface 72y, and the bleeding site E can be stopped (see FIG. 9B).

  The thus configured laser chips 70, 70x, 70y are detachably attached to the laser irradiation port 63a so as to be attached to the laser irradiation port 63a that irradiates the laser light 57a provided at the tip of the hollow waveguide 63. A laser transmission path mounting part 71, a contact part 72 that comes into contact with the living tissue, and an open space S in front of the irradiation direction of the laser light 57a emitted from the laser irradiation port 63a to the laser transmission path mounting part 71. And a connecting portion 73 that connects a part of the abutting portion 72 and the laser transmission path mounting portion 71, and the rear of the abutting portion 72 is irradiated forward from the laser irradiation port 63a. By providing the reflecting surface 72b that reflects the laser beam 57a toward the connecting portion 73, the laser medical treatment can be performed safely and can be stopped even when bleeding occurs. That.

  More specifically, the reflecting surface 72b reflects the laser beam 57a irradiated from the laser irradiation port 63a toward the connecting portion 73, so that the reflected laser beam 57a is irradiated to a normal tissue that is not a treatment target. Can be prevented, and damage to normal living tissue can be prevented.

  Further, when the contact portion 72 is irradiated with the laser beam 57a, the contact portion 72 is heated by absorbing the energy of the laser beam 57a. The bleeding part E can be stopped by bringing the contact part 72 thus heated into contact with, for example, a bleeding part E that is bleeding.

  Furthermore, since the connecting portion 73 is configured to connect a part of the abutting portion 72, the laser transmission path mounting portion 71, and the open space S, between the abutting portion 72 and the laser transmission path mounting portion 71. Is formed with an open space S that is open in a direction perpendicular to the laser beam irradiation direction. Accordingly, the submucosa L2 that is fibrotic and difficult to cut can be held so as to be disposed in the open space S, and the held submucosa L2 can be irradiated with the laser light 57a, so that the tissue can be cut reliably. .

  In addition, by providing a contact portion 72 capable of absorbing the laser beam 57a in front of the laser irradiation port 63a, a so-called backstop function can be provided to prevent the laser beam 57a from being irradiated forward. In particular, even when the periphery of a tissue having a thin tissue wall (for example, the muscle layer L3 such as the large intestine) is peeled off, the treatment can be performed without risk of perforation.

  As described above, the laser chips 70, 70x, and 70y can stop the bleeding site E, and the normal tissue may be damaged or perforated by the laser light 57a when irradiated with the reflected light of the laser light 57a. Since it can be prevented, it can be safely performed.

  Further, by forming the reflecting surface 72b with an acute angle with respect to the connecting portion 73, the laser light 57a reflected by the reflecting surface 72b can be reliably reflected to the connecting portion 73, and the reflected light can be expected to a normal tissue. Can be prevented from being irradiated.

  Further, since the reflecting surface 72b and the connecting portion 73 are formed at an acute angle, when the submucosa L2 is held so as to be disposed in the open space S formed by the abutting portion 72 and the laser transmission path mounting portion 71. The tissue of the submucosa L2 can be hooked on the reflecting surface 72b. Thereby, even when the tissue of the submucosa L2 is fibrillated, the tissue can be stably and reliably held, and the laser beam 57a can be reliably irradiated. For example, the affected tissue T can be peeled without perforating the muscle layer L3.

  In tissue separation, the tip of the laser chip 70, 70x, 70y is inserted into the tissue, and the living tissue is stably held in the space of the reflecting surface 72b, the connecting portion 73, and the laser emitting end. Since the laser beam is irradiated while moving the distal end of the treatment instrument in the lateral direction or the front direction, incision and peeling can be easily performed even in a tissue that is difficult to cut, such as a fibrotic tissue.

  Furthermore, by providing a contact convex surface 72x and a contact concave surface 72y or a flat contact surface 72a formed with a curved surface having a curvature radius of 10 mm or more in front of the contact portion 72, the damaged area can be widened. And can stop bleeding reliably.

  Specifically, for example, when a contact convex surface 72x that is a convex curved surface having a curvature radius of +10 mm or more or a flat contact surface 72a is formed in front of the contact portion 72, the contact surface 72a or The abutment convex surface 72x is reliably pressed against the bleeding site E, and the abutment portion 72 is irradiated with the laser beam 57a, thereby absorbing the energy of the laser beam 57a and heating the abutment surface 72a of the abutment portion 72. In addition, the bleeding site E and the blood B around the contacted convex surface 72x can be coagulated to reliably stop bleeding.

On the other hand, when the contact concave surface 72y that is a concave curved surface having a radius of curvature of −10 mm or more is formed, the blood B that has flowed out from the bleeding site E is pressed by pressing the contact concave surface 72y against the bleeding site E. The blood B accumulated in the contact concave surface 72y can be coagulated by the contact part 72 heated by irradiating the laser beam, and the bleeding site E can be stopped.
As described above, since the hemostasis using the contact portion 72 having a different abutment surface or a flat abutment portion 72 has a different action of hemostasis, the radius of curvature differs depending on the bleeding site and the bleeding situation. A curved surface or a flat contact portion 72 can be used properly.

  Further, since the connecting portion 73 is provided with a protruding portion 74 that protrudes toward the optical axis of the laser beam 57a emitted from the laser irradiation port 63a and has a convex cross-sectional shape viewed from the optical axis, The tissue of the submucosa L2 can be held at a predetermined position in the open space S, and the laser beam 57a can be reliably irradiated to the tissue of the submucosa L2.

  More specifically, even if the tissue of the submucosa L2 is held by the connecting portion that does not have the protrusion 74 and the contact portion 72, the tissue of the submucosa L2 can be disposed at a position where the laser light 57a is irradiated. It was difficult. However, the tissue of the submucosa L2 can be disposed in the projecting portion 74 by providing the connecting portion 73 with the projecting portion 74 projecting toward the optical axis of the laser beam 57a. Thereby, the laser beam 57a can be irradiated to a desired position of the living tissue, and the tissue of the submucosa L2 can be cut at the desired position.

  Furthermore, by forming the cross-sectional shape of the protruding portion 74 in a triangular shape with the optical axis side protruding at an acute angle, it is possible to assist the cutting portion 74 in cutting the tissue of the submucosa L2.

  Further, since the reflection surface 72b is coated on the surface to reduce the reflection of the laser beam 57a, the energy of the laser beam 57a absorbed by the contact portion 72 can be increased, and the contact portion 72 is made efficient. Can be heated well. Thereby, when the contact part 72 is made to contact | abut to the damaged site | part bleeding in the biological tissue, it can stop hemostasis reliably.

  Furthermore, since the contact portion 72 is provided with an anti-adhesion coating that prevents the contact with the living tissue, the contact surface 72a brought into contact with the living tissue is prevented from being fixed to the living tissue. In addition, when the contact surface 72a is separated from the bleeding site E that has stopped, damage to the bleeding site E and the like can be prevented.

In the correspondence between the configuration of the present invention and the above-described embodiment, the mounting portion of the present invention corresponds to the laser transmission path mounting portion 71,
Similarly,
The reflecting portion corresponds to the reflecting surface 72b,
The contact surface corresponds to the contact surface 72a, the contact convex surface 72x, the contact concave surface 72y,
The laser oscillator corresponds to the laser oscillation unit 57,
The endoscope corresponds to the endoscope apparatus 10,
The present invention is not limited only to the configuration of the above-described embodiment, and many embodiments can be obtained.

  For example, in the present embodiment, the connecting portion 73 is configured to connect the lower part of the laser transmission path mounting portion 71 and the contact portion 72, but the open space S is between the mounting portion 71 and the contact portion 72. As long as it can be secured, there is no need for a part to be connected.

  The reflection surface 72b may have any configuration as long as the laser beam 57a can be reflected toward the connecting portion 73. For example, the reflection surface 72b is refracted using a planar or concave reflection surface 72b, a combination of a plurality of reflection surfaces 72b, a prism, or the like. A configuration in which the laser beam 57 a is reflected toward the connecting portion 73 may be used.

  Furthermore, the anti-adhesion coating applied to the contact surface 72a may be any coating as long as it does not adhere to the living tissue, such as titanium nitride (TiN), silicon carbide (SiC), nitride Silicon, boron nitride (BN), or the like may be used.

  In this embodiment, a laser oscillator using a carbon dioxide laser is used. However, the laser oscillator does not necessarily need to be a carbon dioxide laser and can be used for laser treatment using other laser light.

  In the present embodiment, the laser transmission path 60 is constituted by a hollow waveguide. However, the laser transmission path 60 is not necessarily a hollow waveguide, and various laser transmission paths can be used, for example, solid fibers.

DESCRIPTION OF SYMBOLS 1 Laser treatment system 10 Endoscope 50 Laser treatment apparatus 57 Laser oscillation part 57a Laser beam 60 Laser transmission path 63 Hollow waveguide 63a Laser irradiation port 70, 70x, 70y Laser chip
71 Mounting part 72 Contact part 73 Connecting part 72b Reflecting surface 72a Contact surface 72x Contact convex surface 72y Contact concave surface 74 Projection

Claims (10)

A laser chip attached to a laser irradiation port for irradiating a laser beam provided at the tip of a laser transmission path,
A mounting part detachably attached to the laser irradiation port;
A contact portion that contacts the living tissue;
With respect to the mounting part, it is arranged with an open space in front of the irradiation direction of the laser light irradiated from the laser irradiation port, and is composed of a connecting part that connects the contact part and the mounting part,
A laser chip provided at a rear portion of the contact portion with a reflection portion that reflects the laser light emitted forward from the laser irradiation port toward the connection portion. The reflective portion is
The laser chip according to claim 1, comprising a reflective surface that forms an acute angle with respect to the connecting portion. 3. The laser chip according to claim 1, wherein a contact surface formed of a curved surface having a curvature radius of 10 mm or more or a flat surface is provided in front of the contact portion. The connecting portion is
The protrusion part which protruded toward the optical axis of the said laser beam irradiated from the said laser irradiation opening and in which the cross-sectional shape seen from the said optical axis was formed in convex shape was provided. The laser chip according to any one of the above. The laser chip according to claim 4, wherein the cross-sectional shape of the projecting portion is a triangular shape having an acute angle on the optical axis side.   The laser chip according to claim 1, wherein a surface of the reflection portion is coated to reduce reflection of the laser light.   The laser chip according to any one of claims 1 to 6, wherein the contact portion is provided with an anti-adhesion coating for preventing adhesion to a living tissue. A laser transmission path for guiding the laser beam to the site to be treated;
A laser treatment device comprising the laser chip according to claim 1. A laser oscillator that oscillates carbon dioxide laser light;
A laser transmission path for guiding the laser light oscillated from the laser oscillator to a treatment target site;
A laser treatment apparatus comprising the laser chip according to claim 1. A laser treatment device according to claim 8;
A laser treatment system comprising an endoscope that can be inserted through the laser transmission path.

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