U.S. patent application number 11/511197 was filed with the patent office on 2008-02-28 for fistulectomy method between first duct and second duct, ultrasonic endoscope, catheter with balloon, magnet retaining device, and magnet set.
This patent application is currently assigned to OLYMPUS MEDICAL SYSTEMS CORP.. Invention is credited to Kunihide Kaji, Takayasu Mikkaichi, Akiko Mizunuma, Masatoshi Sato, Junji Shiono, Takayuki Suzuki.
Application Number | 20080051626 11/511197 |
Document ID | / |
Family ID | 38686789 |
Filed Date | 2008-02-28 |
United States Patent
Application |
20080051626 |
Kind Code |
A1 |
Sato; Masatoshi ; et
al. |
February 28, 2008 |
Fistulectomy method between first duct and second duct, ultrasonic
endoscope, catheter with balloon, magnet retaining device, and
magnet set
Abstract
A fistulectomy method of forming a fistula between a first duct
and a second duct includes sticking a puncture needle into the
second duct from the inside of the first duct through a wall
surface of the first duct and a wall surface of the second duct,
arranging the puncture needle at a position of a central axis and
sticking a coil needle around the puncture needle from the first
duct toward the second duct to couple the first duct with the
second duct, maintaining the coil needle in a state where the first
duct communicates with the second duct, and forming the fistula on
an inner side of the coil needle.
Inventors: |
Sato; Masatoshi;
(Yokohama-shi, JP) ; Kaji; Kunihide;
(Hachioji-shi, JP) ; Suzuki; Takayuki;
(Yokohama-shi, JP) ; Shiono; Junji; (Yokohama-shi,
JP) ; Mikkaichi; Takayasu; (Fuchu-shi, JP) ;
Mizunuma; Akiko; (Hachioji-shi, JP) |
Correspondence
Address: |
SCULLY SCOTT MURPHY & PRESSER, PC
400 GARDEN CITY PLAZA, SUITE 300
GARDEN CITY
NY
11530
US
|
Assignee: |
OLYMPUS MEDICAL SYSTEMS
CORP.
Tokyo
JP
|
Family ID: |
38686789 |
Appl. No.: |
11/511197 |
Filed: |
August 28, 2006 |
Current U.S.
Class: |
600/101 ;
606/185 |
Current CPC
Class: |
A61B 2017/0649 20130101;
A61B 17/3478 20130101; A61B 1/00179 20130101; A61B 17/1114
20130101; A61B 2017/00876 20130101; A61B 8/4416 20130101; A61B
2017/0417 20130101; A61B 2017/3425 20130101; A61B 2017/1103
20130101; A61B 17/068 20130101; A61B 1/00082 20130101; A61B
2017/1117 20130101; A61B 1/018 20130101; A61B 17/00491 20130101;
A61B 2017/00818 20130101; A61B 8/445 20130101; A61B 1/31 20130101;
A61B 2017/00278 20130101; A61B 2017/06052 20130101; A61B 8/12
20130101; A61B 2017/1139 20130101; A61B 17/221 20130101 |
Class at
Publication: |
600/101 ;
606/185 |
International
Class: |
A61B 17/34 20060101
A61B017/34; A61B 1/00 20060101 A61B001/00 |
Claims
1. A fistulectomy method of forming a fistula between a first duct
and a second duct, comprising: sticking a puncture needle into the
second duct from the inside of the first duct through a wall
surface of the first duct and a wall surface of the second duct;
arranging the puncture needle at a position of a central axis and
sticking a coil needle around the puncture needle from the first
duct toward the second duct to couple the first duct with the
second duct; maintaining the coil needle in a state where the first
duct communicates with the second duct; and forming the fistula on
an inner side of the coil needle.
2. The fistulectomy method according to claim 1, further
comprising: using an ultrasonic observing function of an endoscope
to recognize a position of the second duct before sticking the
puncture needle from the inside of the first duct toward the second
duct.
3. The fistulectomy method according to claim 1, further
comprising: discharging an electroconductive evagination member
having an electroconductive cord-like member fixed at a central
part thereof from a distal end of the puncture needle to arrange
the evagination member in the second duct when the puncture needle
is stuck into the second duct; and pulling the cord-like member
toward the first duct side and pushing an inner wall of the second
duct by the evagination member to allow the second duct to be
appressed against the first duct.
4. The fistulectomy method according to claim 3, further
comprising: discharging the evagination member to the first duct
from the second duct through the inside of the coil needle in a
state where a current is flowed through the cord-like member and
the evagination member.
5. The fistulectomy method according to claim 1, further
comprising: sticking the coil needle around the puncture needle to
couple the first duct with the second duct in a state where a
proximal end of the coil needle is engaged with a distal end of an
over-tube; and releasing engagement between the over-tube and the
coil needle to maintain the coil needle in a state where the first
duct communicates with the second duct.
6. An ultrasonic endoscope comprising: an elongated insertion
section having a distal end and a proximal end; and an operation
section provided at the proximal end of the insertion section,
wherein the insertion section includes on a distal end surface at
the distal end a distal end hard portion having an ultrasonic
transducer, a forceps channel opening portion and an object lens on
a straight line.
7. A fistulectomy method of forming a fistula between a first duct
and a second duct, comprising: sticking a puncture needle toward
the outside of the first duct from the inside of the first duct;
discharging an adhesive to a space between the first duct and the
second duct from the puncture needle; relatively moving the first
duct and the second duct closer to each other and bonding outer
wall surfaces of the first duct and the second duct to each other
by using the adhesive; and forming the fistula on an inner side of
an edge of a part where the outer wall surfaces are bonded to each
other.
8. The fistulectomy method according to claim 7, comprising: using
an endoscope to endoscopically lead the puncture needle to the
first duct.
9. The fistulectomy method according to claim 8, further
comprising: bending a bending portion of the insertion section of
the endoscope and moving the first duct toward the second duct side
to bond the first duct to the second duct.
10. A fistulectomy method of forming a fistula between a first duct
and a second duct, comprising: pushing an inner wall of the first
duct toward the second duct; giving an energy to the inner wall of
the first duct to connect the first duct with the second duct in a
state where the first duct is in contact with the second duct; and
forming the fistula on an inner side of an edge of a part where the
first duct is connected with the second duct.
11. A fistulectomy method of forming a fistula between a first duct
and a second duct, comprising: sticking a puncture needle into the
second duct from the first duct; arranging in the second duct a
first balloon provided at a distal end of an outer peripheral
surface of a cylindrical member through a punctured part into which
the puncture needle is stuck; inflating the first balloon; pushing
an inner wall of the second duct toward the first duct side to move
the second duct toward the first duct in a state where the first
balloon is inflated, and arranging in the first duct a second
balloon provided on a proximal end side of the first balloon on the
outer peripheral surface of the cylindrical member; inflating the
second balloon to hold the wall surfaces of the first and second
ducts; holding the wall surfaces of the first and second ducts
between the first and second balloons to allow the first and second
ducts to adhere to each other in a state where the punctured part
is maintained on the outer peripheral surface of the cylindrical
member; and deflating the first and second balloons and pulling out
the cylindrical member from the punctured part to form the
fistula.
12. The fistulectomy method according to claim 11, further
comprising: moving the second balloon to the first balloon to
reduce a distance between the first balloon and the second balloon
when the second balloon is inflated to hold the first and second
ducts.
13. The fistulectomy method according to claim 11, further
comprising: inflating a third balloon which is provided between the
first and second balloons and has an inflation amount smaller than
those of the first and second balloons to increase a diameter of
the fistula.
14. A catheter with balloons which is arranged in a fistula,
comprising: a cylindrical member having a distal end and a proximal
end; a first balloon provided on an outer peripheral surface at the
distal end of the cylindrical member; a second balloon which is
provided on the outer peripheral surface of the cylindrical member
on a proximal end side of the first balloon; a first fluid duct
which is coupled with the first balloon and through which fluid
flows into/from the first balloon; and a second fluid duct which is
coupled with the second balloon and through which fluid flows
into/from the second balloon.
15. A fistulectomy method of forming a fistula between a first duct
and a second duct, comprising: arranging a first magnet in the
second duct from the first duct; arranging a second magnet larger
than the first magnet in the first duct and holding wall surfaces
of the first and second ducts between the first and second magnets
to exert attraction forces; necrotizing the first and second ducts
by holding based on the attraction forces of the first and second
magnets to form the fistula; and discharging the first magnet into
the first duct through the fistula and dropping the first and
second magnets in the first duct.
16. A magnet retaining device which retains a magnet which is
magnetically attached to the other magnet through a wall surface of
a biomedical tissue, comprising: a puncture needle having a needle
tube at a distal end; a side hole provided in the needle tube; a
magnet provided to allow access from the side hole; and a stylet
which is detachable at a proximal end of the needle tube and
discharges the magnet from the side hole by insertion.
17. A magnet assembly which is magnetically attached to the other
magnet through a wall surface of a biomedical tissue, comprising: a
linear cord-like member; a plurality of magnets into which the
cord-like member is inserted and which are aligned; and a stopper
which is provided to the cord-like member and prevents the magnet
from falling from the cord-like member.
18. The magnet assembly according to claim 17, wherein the
plurality of magnets have a substantially-arc-like shape as a whole
when the magnets adjacent to each other are magnetically attached
to each other.
19. A magnet assembly which is magnetically attached to the other
magnet through a wall surface of a biomedical tissue, comprising:
an annular cord-like member; a plurality of magnets into which the
cord-like member is inserted and which are aligned; and a stopper
which slides in a state where the cord-like member is superimposed
thereon and is configured to increase/reduce a loop shape of the
cord-like member on a side where the magnets are arranged.
20. The magnet assembly according to claim 19, wherein the
plurality of magnets have a substantially-arc-like shape as a whole
when the magnets adjacent to each other are magnetically attached
to each other.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of the Invention
[0002] The present invention relates to a fistulectomy method of
forming a fistula between a first duct and a second duct, an
ultrasonic endoscope, a catheter with balloons arranged in a
fistula, a magnetic retaining device which retains a magnet which
is magnetically attached to the other magnet through a wall surface
of a biomedical tissue, and a magnet assembly which is magnetically
attached to the other magnet through a wall surface of a biomedical
tissue.
[0003] 2. Description of the Related Art
[0004] U.S. Pat. No. 5,690,656 discloses "Method and apparatus for
creating abdominal visceral anastomoses".
[0005] Yamanouchi et al. (Journal of Nippon Medical School 2002;
69(5)) discloses an intestine-intestinal system magnetic
compression anastomosis which anastomoses, e.g., an oral-side
intestine with an analis intestine by using a pair of magnets. When
the pair of magnets are retained and attached to each other with
wall surfaces of intestines sandwiched therebetween, the two
intestinal wall layers sandwiched between the magnets are gradually
led to avascular necrosis. At this time, the intestinal walls which
are in contact with each other adhere to each other, and a hole is
formed.
BRIEF SUMMARY OF THE INVENTION
[0006] According to one aspect of the present invention, there is
provided a fistulectomy method of forming a fistula between a first
duct and a second duct, including:
[0007] sticking a puncture needle into the second duct from the
inside of the first duct through a wall surface of the first duct
and a wall surface of the second duct;
[0008] arranging the puncture needle at a position of a central
axis and sticking a coil needle around the puncture needle from the
first duct toward the second duct to couple the first duct with the
second duct;
[0009] maintaining the coil needle in a state where the first duct
communicates with the second duct; and
[0010] forming the fistula on an inner side of the coil needle.
[0011] According to another aspect of the present invention, there
is provided an ultrasonic endoscope including; an elongated
insertion section having a distal end and a proximal end; and an
operation section provided at the proximal end of the insertion
section. The insertion section has at the distal end a distal end
hard portion having an ultrasonic transducer, a forceps opening
portion and an object lens in alignment.
[0012] Additional objects and advantages of the invention will be
set forth in the description which follows, and in part will be
obvious from the description, or may be learned by practice of the
invention. The objects and advantages of the invention may be
realized and obtained by means of the instrumentalities and
combinations particularly pointed out hereinafter.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
[0013] The accompanying drawings, which are incorporated in and
constitute a part of the specification, illustrate embodiments of
the invention, and together with the general description given
above and the detailed description of the embodiments given below,
serve to explain the principles of the invention.
[0014] FIG. 1 is a schematic view showing various kinds of organs
(ducts) in which an endoscopic system according to each of first to
11th embodiments of the present invention is used;
[0015] FIG. 2 is a schematic view showing an endoscopic system
according to the first embodiment of the present invention;
[0016] FIG. 3 is a schematic perspective view showing a distal end
of an insertion section of an ultrasonic endoscope in the
endoscopic system according to the first embodiment;
[0017] FIG. 4 is a schematic partial cross-sectional view showing a
distal end of an over-tube in the endoscopic system according to
the first embodiment;
[0018] FIG. 5 is a schematic perspective view showing a state in
which a coil is separated from an inner tube of the over-tube in
the endoscopic system according to the first embodiment;
[0019] FIG. 6 is a schematic view showing a T-bar retaining device
in the endoscopic system according to the first embodiment;
[0020] FIG. 7 is a schematic perspective view showing a needle
structure and a cord-like member and a core portion of an electric
scalpel structure of the T-bar retaining device in the endoscopic
system according to the first embodiment;
[0021] FIG. 8 is a schematic perspective view showing the cord-like
member, a bar and the core portion of the electric scalpel
structure of the T-bar retaining device in the endoscopic system
according to the first embodiment;
[0022] FIG. 9 is a schematic cross-sectional view showing a state
in which the electric scalpel structure is set in the needle
structure of the T-bar retaining device in the endoscopic system
according to the first embodiment;
[0023] FIG. 10 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to form
a puncture in a choledoch duct (a second duct) from an intestine
duodenum (a first duct) with a needle tube in the needle structure
of the T-bar retaining device and then the bar is discharged into
the choledoch duct.
[0024] FIG. 11 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to push
an inner wall of the choledoch duct with the bar of the T-bar
retaining device arranged in the choledoch duct so that the
choledoch approaches the intestinal duodenum;
[0025] FIG. 12 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to
approach the choledoch duct to the intestinal duodenum and then the
coil of the over-tube pierces the intestinal duodenum and the
choledoch duct;
[0026] FIG. 13 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to
cause the coil of the over-tube to pierce the intestinal duodenum
and the choledoch duct and then the coil is separated from the
inner tube of the over-tube;
[0027] FIG. 14 is a schematic view showing a state where the
endoscopic system according to the first embodiment is used to
energize the bar of the T-bar retaining device and a fistula is
formed on an inner side of the coil;
[0028] FIG. 15 is a schematic view showing a state where the
endoscopic system according to the first embodiment is used to form
the fistula and then a basket forceps is inserted into the
choledoch duct from the fistula to acquire a calculus by a basket
portion;
[0029] FIG. 16 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to form
the fistula and then the fistula which is no longer necessary is to
be closed by using a clip;
[0030] FIG. 17 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to form
the fistula and then the fistula which is no longer necessary is
closed by using the clip;
[0031] FIG. 18 is a schematic view showing a state in which the
endoscopic system according to the first embodiment is used to
anastomose a stomach with a jejunum of a small intestine;
[0032] FIG. 19 is a schematic view showing an endoscopic system
according to a second embodiment of the present invention;
[0033] FIG. 20 is a schematic view showing a distal end of an
insertion section of an endoscope in the endoscopic system
according to the second embodiment;
[0034] FIG. 21 is a schematic cross-sectional view showing a state
where a balloon is arranged at the distal end of the insertion
section of the endoscope in the endoscopic system according to the
second embodiment and the balloon is inflated;
[0035] FIG. 22 is a schematic view showing a puncture needle for
ultrasonic observation in the endoscopic system according to the
second embodiment;
[0036] FIG. 23 is a schematic view showing that a stylet and a
syringe can be attached to/detached from a proximal end of an
operation section of the puncture needle for ultrasonic observation
in the endoscopic system according to the second embodiment;
[0037] FIG. 24 is a schematic view showing a state in which the
endoscopic system according to the second embodiment is used to
bring an ultrasonic transducer into contact with an inner wall of
an intestinal duodenum in order to confirm a position of a
choledoch duct and then a needle tube of the puncture needle for
ultrasonic observation is arranged between the intestinal duodenum
and the choledoch duct;
[0038] FIG. 25 is a schematic view showing a state in which the
endoscopic system according to the second embodiment is used to
arrange the needle tube of the puncture needle for ultrasonic
observation between the intestinal duodenum and the choledoch duct
and then an adhesive is discharged from a distal end of the needle
tube;
[0039] FIG. 26 is a schematic view showing a state in which the
endoscopic system according to the second embodiment is used to
discharge the adhesive from the distal end of the needle tube of
the puncture needle for ultrasonic observation and then a bending
portion of an insertion section of an endoscope is bent to move and
bond the intestinal duodenum to a choledoch duct side by
pushing;
[0040] FIG. 27 is a schematic view showing a state where the
endoscopic system according to the second embodiment is used to
bond the intestinal duodenum and the choledoch duct to each other
and then a fistula is formed at a bonded part;
[0041] FIG. 28 is a schematic view showing a state where the
endoscopic system according to the second embodiment is used to
discharge the adhesive from the distal end of the needle tube of
the puncture needle for ultrasonic observation and then the
intestinal duodenum is pushed toward and bonded to the choledoch
duct side by utilizing inflation of a balloon arranged at the
distal end of the insertion section of the endoscope;
[0042] FIG. 29 is a schematic view showing a state in which an
ultrasonic wave for an ultrasonic treatment is generated from a
distal end of an insertion section of an ultrasonic endoscope in an
endoscopic system according to a third embodiment to conglutinate
an intestinal duodenum and a choledoch duct;
[0043] FIG. 30 is a schematic view showing a state where an energy
treatment instrument for ultrasonic treatment is protruded from a
distal end opening portion of a forceps channel of the endoscope in
the endoscopic system according to the third embodiment to
conglutinate the intestinal duodenum and the choledoch duct by
using the energy treatment instrument;
[0044] FIG. 31 is a schematic vertical cross-sectional view showing
a balloon retaining device and a catheter with balloons attached at
a distal end of the balloon retaining device in an endoscopic
system according to a fourth embodiment of the present
invention;
[0045] FIG. 32 is a schematic vertical cross-sectional view showing
a state in which engagement of the catheter with balloons is
released from the distal end of the balloon retaining device in the
endoscopic system according to the fourth embodiment;
[0046] FIGS. 33A and 33B are schematic views showing that a state
where the catheter with balloons is attached to the balloon
retaining device in the endoscopic system according to the fourth
embodiment is observed from a direction of an arrow 33 in FIG.
31;
[0047] FIG. 34 is a schematic vertical cross-sectional view showing
a state in which a balloon of the catheter with balloons which
maintains a fistula is deflated by the endoscopic system according
to the fourth embodiment;
[0048] FIG. 35 is a schematic vertical cross-sectional view showing
a state in which the balloon of the catheter with balloons which
maintains the fistula is inflated by the endoscopic system
according to the fourth embodiment;
[0049] FIG. 36 is a schematic view showing a state in which the
endoscopic system according to the fourth embodiment is used to
form a puncture from an intestinal duodenum to a choledoch duct
with a needle member of the balloon retaining device and then the
balloon of the catheter with balloons on the distal end side is
arranged in the choledoch duct;
[0050] FIG. 37 is a schematic view showing a state in which the
endoscopic system according to the fourth embodiment is used to
arrange in the choledoch duct the balloon of the catheter with
balloons on the distal end side and then the balloon on the distal
end side is inflated;
[0051] FIG. 38 is a schematic view showing a state in which the
endoscopic system according to the fourth embodiment is used to
inflate the balloon of the catheter with balloons on the distal end
side in the choledoch duct, then the balloon retaining device is
pulled toward an operator's hand side and, a balloon on a proximal
side is arranged in the intestinal duodenum and inflated to hold
wall surfaces of the intestinal duodenum and the choledoch
duct;
[0052] FIG. 39 is a schematic view showing a state in which both
balloons of the catheter with balloons in the endoscopic system
according to a fourth embodiment are used to hold the wall surfaces
of the intestinal duodenum and the choledoch duct and then the
needle member is removed from a distal end of an inner sheath in
order to detach the catheter with balloons from the balloon
retaining device;
[0053] FIG. 40 is a schematic view showing a state in which both
balloons of the catheter with balloons in the endoscopic system
according to the fourth embodiment are used to hold the wall
surfaces of the intestinal duodenum and the choledoch duct and
retention is carried out until both wall surfaces are conglutinated
and the fistula enters a stable condition;
[0054] FIG. 41 is a schematic view showing a state in which the
catheter with balloons in the endoscopic system according to the
fourth embodiment is used to form the fistula and then the catheter
with balloons is removed;
[0055] FIG. 42A is a schematic vertical cross-sectional view
showing a state where fluid is supplied to the balloon of the
catheter with balloons in the endoscopic system according to the
fourth embodiment or a duct extending from the balloon stays in the
intestinal duodenum, wherein the catheter with balloons depicted in
FIGS. 34 and 35 is modified;
[0056] FIG. 42B is a schematic perspective view showing a state
where fluid is supplied to the balloon of the catheter with
balloons in the endoscopic system according to the fourth
embodiment or a duct extending from the balloon stays in the
intestinal duodenum, wherein the catheter with balloons depicted in
FIGS. 34 and 35 is modified;
[0057] FIG. 43 is a schematic vertical cross-sectional view showing
a state in which a check valve is provided at a proximal end of a
duct of the catheter with balloons depicted in FIGS. 42A and 42B in
the endoscopic system according to the fourth embodiment;
[0058] FIG. 44 is a schematic partial vertical cross-sectional view
showing a state where a narrow tube is inserted into the proximal
end of the duct of the catheter with balloons depicted in FIG. 43
in the endoscopic system according to the fourth embodiment;
[0059] FIG. 45A is a schematic vertical cross-sectional view
showing a state where the balloon of the catheter with balloons is
inflated by using the narrow tube depicted in FIG. 44 in the
endoscopic system according to the fourth embodiment and then a cut
is formed at a part of the duct in order to deflate the
balloon;
[0060] FIG. 45B is a schematic vertical cross-sectional view
showing a state in which the balloon of the catheter with balloons
is inflated by using the narrow tube depicted in FIG. 44 in the
endoscopic system according to the fourth embodiment and then the
duct is cut in order to deflate the balloon;
[0061] FIG. 46 is a schematic vertical cross-sectional view showing
a balloon retaining device and a catheter with balloons attached at
a distal end of this balloon retaining device in an endoscopic
system according to a fifth embodiment of the present
invention;
[0062] FIG. 47A is a schematic vertical cross-sectional view
showing the catheter with balloons in the endoscopic system
according to the fifth embodiment, especially a state in which a
balloon on a distal end side is separated from a balloon on a
proximal end side;
[0063] FIG. 47B is a schematic vertical cross-sectional view
showing the catheter with balloons in the endoscopic system
according to the fifth embodiment, especially a state in which the
balloon on the distal end side and the balloon on the proximal end
side are moved closer to each other by a ratchet mechanism;
[0064] FIG. 48 is a schematic view showing a state in which the
endoscopic system according to the fifth embodiment is used to form
a puncture from an intestinal duodenum to a choledoch duct with a
needle member of the balloon retaining device and then the balloon
of the catheter with balloons on the distal end side is arranged in
the choledoch duct;
[0065] FIG. 49 is a schematic view showing a state in which the
endoscopic system according to the fifth embodiment is used to
arrange the balloon of the catheter with balloons on the distal end
side in the choledoch duct and then the balloon on the distal end
side is inflated;
[0066] FIG. 50 is a schematic view showing a state in which the
endoscopic system according to the fifth embodiment is used to
inflate the balloon of the catheter with balloons on the distal end
side is inflated in the choledoch duct, then the balloon retaining
device is pulled toward an operator's hand side and the balloon on
the proximal end side is arranged in the intestinal duodenum and
inflated;
[0067] FIG. 51 is a schematic view showing a state in which the
endoscopic system according to the fifth embodiment is used to
inflate both balloons of the catheter with balloons and then the
balloon on the proximal end side is moved closer to the balloon on
the distal end side to hold wall surfaces of the intestinal
duodenum and the choledoch duct therebetween;
[0068] FIG. 52 is a schematic vertical cross-sectional view showing
a catheter with balloons in an endoscopic system according to a
sixth embodiment;
[0069] FIG. 53 is a schematic vertical cross-sectional view showing
a state in which the wall surfaces of the intestinal duodenum and
the choledoch duct are held between the balloons of the catheter
with balloons on the distal end side and the proximal end side in
the endoscopic system according to the sixth embodiment and an
opening diameter of a fistula is increased by using a small balloon
arranged between them;
[0070] FIG. 54A is a schematic vertical cross-sectional view
showing a state in which a magnet is arranged in a needle tube at a
distal end of a puncture needle for ultrasonic observation in an
endoscopic system according to a seventh embodiment of the present
invention;
[0071] FIG. 54B is a schematic perspective view showing the distal
end of the puncture needle for ultrasonic observation in the
endoscopic system according to the seventh embodiment;
[0072] FIG. 55 is a schematic vertical cross-sectional view showing
a state in which the magnet is discharged from a side hole of the
needle tube at the distal end of the puncture needle for ultrasonic
observation in the endoscopic system according to the seventh
embodiment;
[0073] FIG. 56 is a schematic view showing a state in which the
endoscopic system according to the seventh embodiment is used to
form a puncture from an intestinal duodenum to a choledoch duct
with the needle tube of the puncture needle for ultrasonic
observation and then the magnetic is discharged into the choledoch
duct from the side hole of the needle tube;
[0074] FIG. 57 is a schematic view showing a state in which the
endoscopic system according to the seventh embodiment is used to
arrange a magnet (a first magnet) in the choledoch duct and then a
magnet (a second magnet) larger than the magnet arranged in the
choledoch duct is endoscopically arranged in the intestinal
duodenum;
[0075] FIG. 58 is a schematic view showing a state in which the
first magnet arranged in the choledoch duct and the second magnet
arranged in the intestinal duodenum by using the endoscopic system
according to the seventh embodiment exercise attraction forces on
each other and are thereby magnetically attached to each other
through wall surfaces of the choledoch duct and the intestinal
duodenum;
[0076] FIG. 59 is a schematic view showing a state in which a
tissue of a part compressed by the first and second magnets
magnetically attached to each other through the wall surfaces of
the choledoch duct and the intestinal duodenum by using the
endoscopic system according to the seventh embodiment necroses due
to ischemia and a fistula is thereby formed;
[0077] FIG. 60 is a schematic view showing an endoscopic system
according to an eighth embodiment of the present invention;
[0078] FIG. 61 is a schematic partial cross-sectional view showing
a magnet assembly retaining device in the endoscopic system
according to the eighth embodiment;
[0079] FIG. 62A is a schematic view showing a magnet assembly
retained by using the magnet assembly retaining device in the
endoscopic system according to the eighth embodiment, especially a
state in which the magnet assembly is arranged in the magnetic
assembly retaining device;
[0080] FIG. 62B is a schematic view showing the magnet assembly
retained by using the magnet assembly retaining device in the
endoscopic system according to the eighth embodiment, especially a
state in which the magnetic assembly is arranged in a desired
duct;
[0081] FIGS. 63A and 63B are schematic perspective views each
showing a magnet used in the magnet assembly in the endoscopic
system according to the eighth embodiment;
[0082] FIG. 64A is a schematic view showing a magnet used in the
magnet assembly in the endoscopic system according to the eighth
embodiment;
[0083] FIG. 64B is a schematic view showing a state in which
magnets can be bent in an appropriate direction while maintaining
coupling of the magnets based on a cord-like member by providing a
bulging shape to an end surface of each magnet used in the magnet
assembly in the endoscopic system according to the eighth
embodiment;
[0084] FIG. 65 is a schematic view showing a state in which a
string or an arc (a circumference) on an inner peripheral side is
formed to be shorter than a string or an arc (a circumference) on
an outer peripheral side in such a manner that an annular shape is
formed when the magnets used in the magnet assembly in the
endoscopic system according to the eighth embodiment are
magnetically attached to each other;
[0085] FIG. 66A is a schematic partial cross-sectional view showing
a state in which the magnet assembly is arranged on an inner side
of a sheath of the magnet assembly retaining device in the
endoscopic system according to the eighth embodiment;
[0086] FIG. 66B is a schematic partial cross-sectional view showing
a state in which a distal end of the cord-like member and a stopper
of the magnet assembly are pulled out from a distal end of the
sheath of the magnet assembly retaining device in the endoscopic
system according to the eighth embodiment;
[0087] FIG. 66C is a schematic partial cross-sectional view showing
a state in which the stopper of the magnet assembly relatively
moves forward to reduce a loop of the cord-like member on the
distal end side by the magnet assembly retaining device in the
endoscopic system according to the eighth embodiment;
[0088] FIG. 66D is a schematic partial cross-sectional view showing
a state in which the magnet assembly is separated from the magnet
assembly retaining device in the endoscopic system according to the
eighth embodiment;
[0089] FIG. 67 is a schematic view showing a state in which the
endoscopic system according to the eighth embodiment is used to
arrange the distal end of the sheath of the magnet assembly
retaining device in a choledoch duct from an intestinal
duodenum;
[0090] FIG. 68 is a schematic view showing a state in which the
magnet assembly retaining device in the endoscopic system according
to the eighth embodiment is used to arrange the magnet assembly
(the first magnet) in the choledoch duct;
[0091] FIG. 69 is a schematic view showing a state in which the
first magnet arranged in the choledoch duct and the second magnet
arranged in the intestinal duodenum by using the endoscopic system
according to the eighth embodiment exert attraction forces on each
other to be magnetically attached to each other through wall
surfaces of the choledoch duct and the intestinal duodenum;
[0092] FIG. 70 is a schematic view showing a state in which, when
the first magnet arranged in the choledoch duct by using the
endoscopic system according to the eighth embodiment has an annular
shape and the second magnet arranged in the intestinal duodenum by
using the same has an annular shape, a puncture is formed at a
position of a concentric axis of these magnets to form a
fistula;
[0093] FIG. 71 is a schematic view showing an example of a magnet
assembly arranged in the choledoch duct by using the endoscopic
system according to the eighth embodiment;
[0094] FIG. 72A is a schematic view showing an example of the
magnet assembly arranged in the choledoch duct by using the
endoscopic system according to the eighth embodiment;
[0095] FIG. 72B is a schematic view showing a state in which
magnets of the magnet assembly depicted in FIG. 72A arranged in the
choledoch duct by using the endoscopic system according to the
eighth embodiment are magnetically attached to each other to
provide a substantially annular shape;
[0096] FIG. 72C is a schematic view showing a state in which
magnets of the magnet assembly depicted in FIG. 72A arranged in the
choledoch duct by using the endoscopic system according to the
eighth embodiment are magnetically attached to each other to
provide a substantially annular shape;
[0097] FIG. 73A is a schematic view showing a magnet used in the
magnet assembly in the endoscopic system according to the eighth
embodiment;
[0098] FIG. 73B is a schematic view showing a non-magnetic body
used in the magnet assembly in the endoscopic system according to
the eighth embodiment;
[0099] FIG. 73C is a schematic view showing a state in which the
magnets depicted in FIG. 73A used in the magnet assembly in the
endoscopic system according to the eighth embodiment are aligned in
a C-like form and the non-magnetic bodies illustrated in FIG. 73B
are arranged between the magnets;
[0100] FIG. 73D is a schematic view showing a state of a magnetic
force of the magnet assembly depicted in FIG. 73C used in the
magnet assembly in the endoscopic system according to the eighth
embodiment;
[0101] FIG. 74A is a schematic view showing a state in which two
magnets used in the magnet assembly in the endoscopic system
according to the eighth embodiment are coupled with each other;
[0102] FIG. 74B is a schematic view showing a state of a magnetic
force of the magnet assembly depicted in FIG. 74A used in the
magnet assembly in the endoscopic system according to the eighth
embodiment;
[0103] FIG. 75 is a schematic view showing a state in which the
distal end of the sheath of the magnet assembly retaining device in
the endoscopic system according to the eighth embodiment is
arranged in the choledoch duct from a papilla of the intestinal
duodenum in order to arrange the magnet assembly in the choledoch
duct;
[0104] FIG. 76 is a schematic view showing a state in which the
magnet assembly in the endoscopic system according to the eighth
embodiment is to be arranged in the choledoch duct through a tube
used for percutaneous transhepatic cholangial drainage;
[0105] FIG. 77A is a schematic partial cross-sectional view showing
a magnet assembly retaining device in an endoscopic system
according to a ninth embodiment of the present invention;
[0106] FIG. 77B is a schematic view showing a state in which a
sheath of the magnet assembly retaining device in the endoscopic
system according to the ninth embodiment is observed from a
direction of an arrow 77B in FIG. 77A;
[0107] FIG. 78 is a schematic cross-sectional view showing a state
in which a magnet assembly is arranged in the magnet assembly
retaining device in the endoscopic system according to the ninth
embodiment;
[0108] FIG. 79 is a schematic vertical cross-sectional view showing
magnets used in the magnet assembly in the endoscopic system
according to the ninth embodiment;
[0109] FIG. 80A is a schematic vertical cross-sectional view
showing a distal end stopper used in the magnet assembly in the
endoscopic system according to the ninth embodiment;
[0110] FIG. 80B is a schematic vertical cross-sectional view
showing a state in which the distal end stopper used in the magnet
assembly in the endoscopic system according to the ninth embodiment
is engaged with a wedge-like member which is engaged with the
distal end stopper when a strong force is applied thereto;
[0111] FIG. 81A is a schematic vertical cross-sectional view
showing a proximal end stopper used in the magnet assembly in the
endoscopic system according to the ninth embodiment;
[0112] FIG. 81B is a schematic vertical cross-sectional view
showing a state in which the proximal end stopper used in the
magnet assembly in the endoscopic system according to the ninth
embodiment is engaged with a wedge-like member which is engaged
with the proximal end stopper when a strong force is applied
thereto;
[0113] FIG. 82 is a schematic vertical cross-sectional view showing
a spacer used in the magnet assembly in the endoscopic system
according to the ninth embodiment;
[0114] FIG. 83A is a schematic cross-sectional view showing a state
in which a distal end of the sheath is arranged in a choledoch duct
with the magnet assembly being arranged in the magnet assembly
retaining device in the endoscopic system according to the ninth
embodiment;
[0115] FIG. 83B is a schematic cross-sectional view showing a state
in which the distal end stopper of the magnet assembly is protruded
with respect to the distal end of the sheath having the magnet
assembly arranged in the magnet assembly retaining device in the
endoscopic system according to the ninth embodiment and then a
cord-like member in a second lumen is pulled toward an operator's
hand side;
[0116] FIG. 83C is a schematic view showing a state in which a
distance between the proximal stopper and the distal end stopper of
the magnet assembly arranged in the magnet assembly retaining
device in the endoscopic system according to the ninth embodiment
is shortened and the spacer is to enter a tapered edge portion of a
through hole of each magnet;
[0117] FIG. 83D is a schematic view showing a state in which the
magnets adjacent to each other are magnetically attached to each
other when the spacer enters the through hole of each magnet in the
magnet assembly arranged in the magnet assembly retaining device in
the endoscopic system according to the ninth embodiment;
[0118] FIG. 83E is a schematic view showing a state in which the
magnets adjacent to each other in the magnet assembly arranged in
the magnet assembly retaining device in the endoscopic system
according to the ninth embodiment are magnetically attached to each
other and become equivalent to a large magnet having an S pole and
an N pole;
[0119] FIG. 83F is a schematic view showing a state in which the
magnet assembly arranged in the magnet assembly retaining device in
the endoscopic system according to the ninth embodiment is moved
toward the outside from the distal end of the sheath by pushing in
a pusher toward the distal end side of the sheath;
[0120] FIG. 83G is a schematic view showing a state in which the
pusher and the sheath are separated from the magnet assembly
arranged in the magnet assembly retaining device in the endoscopic
system according to the ninth embodiment to arrange the magnet
assembly in the choledoch duct;
[0121] FIG. 84 is a schematic partial cross-sectional view showing
a magnet assembly retaining device in an endoscopic system
according to a 10th embodiment of the present invention;
[0122] FIG. 85A is a schematic cross-sectional view showing a state
in which a distal end of a sheath of the magnet assembly retaining
device is arranged in a choledoch duct with a magnet assembly being
arranged in the magnet assembly retaining device in the endoscopic
system according to the 10th embodiment;
[0123] FIG. 85B is a schematic cross-sectional view showing a state
in which, when a proximal end stopper is pushed by a pusher with
the magnet assembly being arranged in the magnet assembly retaining
device in the endoscopic system according to the 10th embodiment,
magnets protrude from the distal end of the sheath and a
biocompatible spacer arranged between the magnets falls into the
choledoch duct;
[0124] FIG. 85C is a schematic cross-sectional view showing a state
in which, when the proximal end stopper is further pushed by the
pusher with the magnet assembly being arranged in the magnet
assembly retaining device in the endoscopic system according to the
10th embodiment, the magnets protrude from the distal end of the
sheath and the biocompatible spacer arranged between the magnets
falls in the choledoch duct;
[0125] FIG. 85D is a schematic cross-sectional view showing a state
in which the proximal end stopper is further pushed by the pusher
to protrude from the distal end of the sheath of the magnet
assembly retaining device with the magnet assembly being arranged
in the magnet assembly retaining device in the endoscopic system
according to the 10th embodiment;
[0126] FIG. 85E is a schematic view showing a state in which the
proximal end stopper of the magnet assembly is protruded from the
distal end of the sheath of the magnet assembly retaining device in
the endoscopic system according to the 10th embodiment and then the
magnet assembly is arranged in the choledoch duct;
[0127] FIG. 86 is a schematic partial cross-sectional view showing
a magnet assembly retaining device in an endoscopic system
according to an 11th embodiment of the present invention;
[0128] FIG. 87A is a schematic cross-sectional view showing a state
in which a distal end of a sheath is arranged in a choledoch duct
with a magnet assembly being arranged in the magnet assembly
retaining device in the endoscopic system according to the 11th
embodiment; and
[0129] FIG. 87B is a schematic cross-sectional view showing a state
in which a proximal end stopper is further pushed by a pusher to
protrude from the distal end of the sheath of magnet assembly
retaining device and collect spacers with the magnet assembly being
arranged in the magnet assembly retaining device in the endoscopic
system according to the 11th embodiment.
DETAILED DESCRIPTION OF THE INVENTION
[0130] The best mode for carrying out the present invention will be
described hereinafter with reference to the accompanying
drawings.
[0131] A first embodiment will now be explained in conjunction with
FIGS. 1 to 18.
[0132] FIG. 1 schematically shows a stomach S, an intestine
duodenum D, a jejunum of a small intestine (which will be mainly
referred to as a jejunum hereinafter) J, a gall bladder G, a
choledoch duct C and others. Further, there may be conducted a
fistulectomy which performs fistulation by anastomosing various
organs (ducts), e.g., the intestine duodenum (a first duct) D with
the choledoch duct (a second duct) C and the stomach (the first
duct) S with the jejunum (the second duct) J. Here, a description
will be mainly given as to a case where a fistula is formed between
the intestine duodenum D and the choledoch duct C in order to flow
bile of the choledoch duct C into the intestinal duodenum D.
[0133] An endoscopic system 10 shown in FIG. 2 is provided with an
ultrasonic endoscope 12, an over-tube 14 and a T-bar retaining
device 16. The T-bar retaining device 16 is endoscopically used
together with the ultrasonic endoscope 12.
[0134] The ultrasonic endoscope 12 includes an elongated insertion
section 22, an operation section 24 provided at a proximal end of
the insertion section 22, and a universal cord 26 extended from the
operation section 24. The insertion section 22 is provided with a
distal end hard portion 32, a bending portion 34 and a flexible
tube portion 36. The bending portion 34 can be curved in a desired
direction by swiveling a bending operation knob 24a of the
operation section 24. The flexible tube portion 36 is bent in
accordance with a shape of a biomedical duct. A forceps channel 38
(see FIG. 3) is inserted into a part from the insertion section 22
to the operation section 24. A proximal end of the forceps channel
38 is provided at the operation section 24. A forceps tap 38b is
arranged in an opening portion (a forceps opening) of the forceps
channel 38 on the proximal end side.
[0135] As shown in FIG. 3, an electronic convex type ultrasonic
transducer 42 for ultrasonic observation, a distal end opening
portion 38a of the forceps channel 38 and an object lens 44 for
optical observation are arranged on a distal end surface of the
distal end hard portion 32. Although not shown, an illumination
lens from which light for optical observation exits is also
arranged on the distal end surface of the distal end hard portion
32.
[0136] Therefore, the ultrasonic endoscope 12 has an ultrasonic
observing function of performing ultrasonic observation of an
object and an optical observing function of effecting optical
observation. A distance with which ultrasonic observation of an
object can be performed varies depending on a frequency given to
the ultrasonic transducer 42, but it is, e.g., approximately 20 mm
to 70 mm from a contact surface on which the ultrasonic transducer
42 comes into contact with a biomedical tissue.
[0137] The ultrasonic transducer 42, the distal end opening portion
38a of the forceps channel 38 and the object lens 44 are arranged
in alignment along a direction perpendicular to an axial direction
of the insertion section 22. In particular, the distal end opening
portion 38a of the forceps channel 38 is arranged on a
substantially central axis of the distal end hard portion 32 (the
insertion section 22), and the ultrasonic transducer 42 and the
object lens 44 are arranged at symmetrical positions with respect
to the distal end opening portion 38a of the forceps channel 38.
That is, the distal end opening portion 38a is arranged at a
central part between the object lens 44 and the ultrasonic
transducer 42.
[0138] As shown in FIG. 4, the over-tube 14 is formed into a double
structure. The over-tube 14 is provided with an outer tube 52, an
inner tube 54 and a coil (a coil needle) 56. It is preferable for
the coil 56 to have insulating properties, and it is more
preferable for the coil 56 to be formed of a bioabsorbable
material. Furthermore, the coil 56 may be formed of a shape-memory
material. The coil 56 is arranged at a distal end of the inner tube
54. A spiral groove 54a is formed on an inner peripheral surface at
the distal end of the inner tube 54. Therefore, the coil 56 is
detachably engaged with (screwed in) the spiral groove 54a on the
inner peripheral surface at the distal end of the inner tube 54 by
friction.
[0139] As shown in FIG. 5, a proximal end of this coil 56 is
rounded in order to prevent a puncture from being formed in the
inner tube 54 when the coil 56 is engaged with the spiral groove
54a of the inner tube 54. On the other hand, a distal end of the
coil 56 protruding with respect to the distal end of the inner tube
54 is formed into a needle-like shape.
[0140] As shown in FIG. 4, the outer tube 52 is movable with
respect to the inner tube 54, and can cover the coil 56 at the
distal end of the inner tube 54 when the insertion section 22 of
the endoscope 12 is inserted into a body cavity.
[0141] As shown in FIG. 6, the T-bar retaining device 16 is
provided with an outer sheath (a main body) 62, a tubular needle
structure 64 and an electric scalpel structure 66. The needle
structure 64 is movable in an inner cavity of the outer sheath 62.
Moreover, the electric scalpel structure 66 is movable in an inner
cavity of the needle structure 64. Since insertion into the forceps
channel 38 of the endoscope 12 is required, an external diameter of
the outer sheath 62 is slightly smaller than a bore diameter of the
forceps channel 38, and the outer sheath 62, the needle structure
64 and the electric scalpel structure 66 are formed to be longer
than a length of the forceps channel 38.
[0142] As shown in FIGS. 6 and 7, the needle structure 64 is
provided with a needle tube 72, a flexible tube (an inner sheath)
74 and a needle slider 76. The needle tube 72 is fixed at a distal
end of the flexible tube 74, and the needle slider 76 is fixed at a
proximal end of the flexible tube 74.
[0143] As shown in FIGS. 6 and 8, the electric scalpel structure 66
includes a rod-like bar (a member (an evagination member) larger
than a cord-like member 84) 82, the cord-like member 84, a core
portion 86 and a core slider 88. The bar 82 is fixed at a distal
end of the cord-like member 84, and a distal end of the core
portion 86 is fixed at a proximal end of the cord-like member 84.
In particular, the distal end of the cord-like member 84 is fixed
at the center of the bar 82. Therefore, when the cord-like member
84 is pulled, a relationship between the bar 82 and the cord-like
member 84 becomes a substantially-T-like form. Further, a length of
the bar 82 is formed to be smaller than an internal diameter of the
coil 56. The core portion 86, the cord-like member 84 and the bar
82 have electroconductivity. Furthermore, the core slider 88 which
is a connector of an electrode is fixed at a proximal end of the
core portion 86. Therefore, a high-frequency current can be flowed
through the core slider 88, the core portion 86, the cord-like
member 84 and the bar 82.
[0144] Moreover, before use of the T-bar retaining device 16, as
shown in FIG. 9, the bar 82 and the cord-like member 84 are fixed
in a state where they are held in the needle tube 72. The core
portion 86 is used as a pusher for the bar 82. Therefore, when the
core slider 88 is moved forward, the core portion 86 moves and the
bar 82 is pushed out from a distal end of the needle tube 72.
[0145] Additionally, the distal end of the needle tube 72 in the
needle structure 64 can be switched between a state where it
protrudes from a distal end of the outer sheath 62 and a state
where it is retracted into the distal end of the outer sheath 62 by
an operation of the needle slider 76. Further, before the bar 82 is
pushed out from the distal end of the needle tube 72, the electric
scalpel structure 66 moves together with the needle structure
64.
[0146] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0147] As shown in FIG. 2, the over-tube 14 having a double
structure is fit on the insertion section 22 of the ultrasonic
endoscope 12. Furthermore, in the over-tube 14, the inner tube 54
is retracted into the outer tube 52 in advance. At this time, the
entire coil 56 engaged with the distal end of the inner tube 54 is
pulled in toward the proximal end side apart from the distal end of
the outer tube 52. In this state, the insertion section 22 of the
endoscope 12 and the distal end of the over-tube 14 are led to the
intestinal duodenum D from the oral route.
[0148] The ultrasonic transducer 42 of the ultrasonic endoscope 12
is brought into contact with an inner wall of the intestinal
duodenum D. Moreover, a position of the choledoch duct C is
confirmed based on an ultrasonic image obtained by transducing the
ultrasonic transducer 42 of the ultrasonic endoscope 12.
[0149] The needle tube 72 of the T-bar retaining device 16 is
pulled in toward the proximal end side apart from the distal end of
the outer sheath 62. Additionally, the outer sheath 62 of the T-bar
retaining device 16 is protruded from the distal end of the
insertion section 22 of the endoscope 12 through the forceps tap
38b of the forceps channel 38 and the distal end opening portion
38a of the forceps channel 38 in the ultrasonic endoscope 12. The
needle slider 76 of the T-bar retaining device 16 is operated to
protrude the distal end of the needle tube 72 from the outer sheath
62.
[0150] Further, the needle tube 72 pierces a wall portion of the
intestinal duodenum D and also pierces a wall surface of the
choledoch duct C. That is, the distal end of the needle tube 72
exists in the choledoch duct C. In this state, the core slider 88
is moved toward a front side. Then, as shown in FIG. 10, the bar 82
is pushed out from the distal end of the needle tube 72 by the core
portion 86 and falls in the choledoch duct C. That is, the bar 82
is arranged in the choledoch duct C. In this state, the needle
slider 76 is moved to pull the distal end of the needle tube 72
into the outer sheath 62. Therefore, the needle tube 72 is removed
from the wall surfaces of the choledoch duct C and the intestinal
duodenum D.
[0151] In this state, the core slider 88 is pulled toward an
operator's hand side with respect to the outer sheath 62.
Therefore, the bar 82 fixed at the distal end of the cord-like
member 84 is pulled toward the operator's hand side. Then, as shown
in FIG. 11, an inner wall of the choledoch duct C is pushed toward
the intestinal duodenum D side by using the bar 82 so that an outer
wall of the choledoch duct C is appressed against an outer wall of
the intestinal duodenum D.
[0152] Here, the outer tube 52 of the over-tube 14 is moved toward
the proximal end side with respect to the inner tube 54. Then, the
coil 56 is exposed to the outer tube 52. The inner tube 54 is
rotated in a predetermined direction (a first direction) in a state
where it covers an outer peripheral surface of the insertion
section 22 of the endoscope 12. Then, as shown in FIG. 12, the coil
56 pierces the wall surface of the intestinal duodenum D and the
inner wall of the choledoch duct C from the needle-like distal end
thereof. When the distal end of the coil 56 reaches the inside of
the choledoch duct C, the inner tube 54 is rotated in a second
direction which is opposite to the first direction. Then,
engagement between the coil 56 and the spiral groove 54a on the
inner peripheral surface of the inner tube 54 at the distal end is
released. Therefore, as shown in FIG. 13, the coil 56 is retained
in a state where the outer wall of the intestinal duodenum D is
appressed against the outer wall of the choledoch duct C.
[0153] Furthermore, a high-frequency power supply (not shown) is
electrically disposed to the core slider (a connector) of the T-bar
retaining device 16. A high-frequency current is flowed through the
core slider 88, the cord-like member 84 and the bar 82 from the
high-frequency power supply. Therefore, as shown in FIG. 14, an
opening is first formed on the wall surface of the choledoch duct C
which is in contact with the bar 82, and an opening is then formed
on the wall surface of the intestinal duodenum D which is appressed
against the wall surface of the choledoch duct C. That is, a
fistula F is formed between the choledoch duct C and the intestinal
duodenum D.
[0154] The coil 56 is gradually absorbed into a living body with
time and eventually disappears if it is formed of a bioabsorbable
material. For example, when the coil 56 disappears, the fistula F
is formed by conglutination of the choledoch duct C and the
intestinal duodenum D. In other words, the intestinal duodenum D is
anastomosed with the choledoch duct C. Therefore, it is possible to
avoid leakage of bile into an abdominal cavity caused due to
separation of the wall surface of the choledoch duct C from the
wall surface of the intestinal duodenum D, and bile in the
choledoch duct C flows toward the intestinal duodenum D side
through the fistula F.
[0155] Moreover, if the coil 56 has insulating properties, safety
is assured even though the bar 82 is brought into contact with the
coil 56 at the time of application of a high-frequency current.
Additionally, when the coil 56 is formed of a shape-memory
material, the shape of the coil 56 is changed to be more compactly
wound by utilizing characteristics of the shape-memory material
when the coil 56 is exposed to a body temperature. At this time,
since the choledoch duct C and the intestinal duodenum D are to be
more closely appressed against each other by utilizing
characteristics of the shape-memory material, a danger of leakage
of bile into an abdominal cavity is reduced, thus facilitating
formation of the fistula.
[0156] A description will be given on a technique of taking out a
calculus C.sub.O in a biliary tract B toward the intestinal
duodenum D side through the fistula (a bypass) F formed from the
biliary tract B (a generic term of a gall bladder, a cystic duct,
an intrahepatic bile duct, a hepatic portal region bile duct and a
choledoch duct) to the intestinal duodenum D by using a side-view
endoscope 90 and a basket forceps 92 as shown in FIG. 15.
[0157] In this case, the basket forceps 92 is inserted into a
forceps channel (not shown) of the endoscope 90. Moreover, a basket
portion 94 of the basket forceps 92 is inserted into the biliary
tract B from the fistula F. The calculus C.sub.O is held in the
basket portion 94 to be taken out from the fistula F. Additionally,
the calculus C.sub.O is discharged to the intestinal duodenum D.
Alternatively, this calculus C.sub.O is collected through the
endoscope 12 while being held in the basket portion 94.
[0158] After removing such a calculus C.sub.O, when the fistula F
is not required, as shown in FIGS. 16 and 17, the fistula F can be
endoscopically closed from the intestinal duodenum D side by using
a clip 96. When the fistula F is closed, it is possible to avoid
complications such as choledochitis which occurs due to inflow of
an intestinal juice into the biliary tract B. Further, the clip 96
naturally falls in the intestinal duodenum D.
[0159] As described above, according to the present invention, the
following matters can be said.
[0160] The coil 56 of the over-tube 14 can be readily screwed into
a biomedical tissue by rotating the inner tube 54 in a periaxial
direction in a state where the coil 56 is attached to the spiral
groove 54a of the inner tube 54. Furthermore, the coil 56 screwed
in the biomedical tissue can be readily separated from the inner
tube 54 by just rotating the inner tube 54 in an opposite
direction. Therefore, the wall surface of the intestinal duodenum D
can be integrated with the wall surface of the choledoch duct C by
a simple operation.
[0161] The ultrasonic transducer 42 for ultrasonic observation, the
distal end opening portion 38a of the forceps channel 38 and the
object lens 44 for optical observation are arranged in alignment,
and the ultrasonic transducer 42 and the object lens 44 are
arranged at the substantially symmetrical positions with respect to
the distal end opening portion 38a of the forceps channel 38.
Therefore, visual points of an ultrasonic observation image and an
optical observation image can be matched with each other.
Therefore, the bar 82 or the cord-like member 84 of the T-bar
retaining device 16 can be easily confirmed when comparing an
ultrasonic observation image with an optical observation image.
[0162] Moreover, since the distal end opening portion 38a is
arranged at a position of the central axis of the distal end hard
portion 32 of the insertion section 22 of the endoscope 12, a
puncture can be made in a part close to the center of the coil 56
of the over-tube 14 by using the needle tube 72 of the T-bar
retaining device 16. Additionally, when forming a fistula by using
the bar 82 of the T-bar retaining device 16, the central axis of
the coil 56 (the inside of the coil 56) can be readily pierced.
[0163] An endoscopic approach can be made from the intestinal
duodenum D side to connect the wall surface of the intestinal
duodenum D with the wall surface of the choledoch duct C through
the fistula F allowing these parts to communicate with each other.
Therefore, when, e.g., occlusion (stricture) occurs in the
choledoch duct C for some reason, the fistula F can be easily
formed to discharge bile in the choledoch duct C to the intestinal
duodenum D.
[0164] It is to be noted that the description has been given as to
the case where the intestinal duodenum D is anastomosed with the
choledoch duct C in this embodiment, but it is also preferable to
anastomose the stomach S with the jejunum J by the same function as
that described in the first embodiment when stricture S.sub.t
occurs in the intestinal duodenum D and a food hardly passes
because of this stricture S.sub.t as shown in FIG. 18. Then, the
food can directly pass to the jejunum J of the small intestine from
the stomach S, thereby improving QOL (Quality Of Life) of a
patient.
[0165] A description will now be given as to a case where the
intestinal duodenum D is anastomosed with the choledoch duct C in
second to 11th embodiments hereinafter, but these embodiments can
be also applied to an anastomosis of the stomach S and the jejunum
J.
[0166] The second embodiment will now be described hereinafter with
reference to FIGS. 19 to 28. This embodiment is a modification of
the first embodiment, and like reference numerals denote members
equal to those described in the first embodiment, thereby omitting
a detailed explanation thereof.
[0167] As shown in FIG. 19, an endoscopic system 10 is provided
with an electronic convex type ultrasonic endoscope 12 and a
puncture needle 116 for ultrasonic observation. Although a detailed
description is not given herein, it is also preferable to use an
over-tube (not shown) in order to assist introduction of an
insertion section 22 of the endoscope 12 into a body cavity.
[0168] As shown in FIG. 20, like the first embodiment, the
endoscope 12 includes the insertion section 22 and an operation
section 24. A distal end hard portion 32 of the insertion section
22 of the endoscope 12 used in this embodiment is provided with an
ultrasonic transducer 122 at a distal end thereof, and an inclined
surface portion 124 on which a distal end opening portion 38a, an
object lens 44 and an illumination lens (not shown) are arranged is
provided on a proximal end side of the ultrasonic transducer 122.
Therefore, the endoscope 12 is provided as a side-view type in
which the object lens 44 and the illumination lens as an optical
observation optical system deviate from an axial direction of the
insertion section 22.
[0169] It is to be noted that, as shown in FIGS. 20 and 21, a
balloon attachment groove 126 is formed between the ultrasonic
transducer 122 and the inclined surface portion 124 in the distal
end hard portion 32 of the insertion section 22 in the endoscope
12. As shown in FIG. 21, a balloon duct 132 having an opening is
formed on an opposite side of the inclined surface portion 124 side
on which the distal end opening portion 38a, the object lens 44 and
the illumination lens are provided, for example. When water (a
liquid) is poured into the balloon duct 132, a balloon 134 fixed on
the balloon attachment groove 126 is inflated. When a suction force
is applied to the balloon duct 132, water which has inflated the
balloon 134 can be removed, thereby deflating the balloon 134.
[0170] As shown in FIG. 22, the puncture needle 116 for ultrasonic
observation is provided with a sheath 142, an operation portion 144
and a needle tube 146 which is formed of, e.g., stainless steel.
The sheath 142 is inserted into a forceps channel 38 of the
endoscope 12. The operation portion 144 is arranged at a proximal
end of the sheath 142. A distal end of the needle tube 146 is
inserted to be movable with respect a distal end of the sheath 142
by the operation portion 144. A stylet 148 is arranged in the
needle tube 146 to be freely inserted/removed.
[0171] The operation portion 144 is provided with an operation
section main body 152 provided at the proximal end of the sheath
142, a slider 154 formed of a resin member slidably provided with
respect to the operation section main body 152, and a stopper 156
which restricts a movable range of the slider 154 provided to the
operation section main body 152.
[0172] The slider 154 is coupled with the needle tube 146.
Therefore, when the slider 154 is moved with respect to the
operation section main body 152, the needle tube 146 moves with
respect to the sheath 142. A suction mouth ring 154a is arranged at
a proximal end of this slider 154. As shown in FIG. 23, a syringe
158 or the stylet 148 is detachable with respect to this suction
mouth ring 154a. In FIG. 22, the stylet 148 is arranged in the
suction mouth ring 154a at the proximal end of the slider 154.
Therefore, when the slider 154 moves with respect to the operation
section main body 152, the needle tube 146 and the stylet 148 move
together.
[0173] Since the needle tube 146 of the puncture needle 116 is
intended for ultrasonic observation, the puncture needle 116 is
inserted into the forceps channel 38 of the ultrasonic endoscope
12. Then, an ultrasonic image of the needle tube 146 is represented
on an ultrasonic observation image in which a target region is
displayed. Thereafter, an operator grasps the slider 154 and
rapidly moves this slider 154 toward the stopper 156. Then, distal
ends of the stylet 148 and the needle tube 146 assuredly pierce a
target region.
[0174] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0175] As explained in the first embodiment, the distal end of the
insertion section 22 of the ultrasonic endoscope 12 is led to an
intestinal duodenum D. Further, a position of a choledoch duct C is
confirmed based on an ultrasonic image.
[0176] As shown in FIG. 24, the distal end of the sheath 142 of the
puncture needle 116 is protruded from the distal end opening
portion 38a of the forceps channel 38 to pierce a wall portion of
the intestinal duodenum D which is close to the choledoch duct C.
Furthermore, as shown in FIGS. 22 and 23, the stylet 148 is removed
from the suction mouth ring 154a at the proximal end of the slider
154 of the operation portion 144 in the puncture needle 116. The
syringe 158 having an adhesive therein is attached in the suction
mouth ring 154a at the proximal end of the slider 154 in place of
the stylet 148. Moreover, as shown in FIG. 25, the adhesive A.sub.h
is discharged from the distal end of the needle tube 146 while
performing observation in an ultrasonic image. It is to be noted
that, as the adhesive A.sub.h, cyanoacrylate adhesive, an adhesive
obtained by dispersing a second liquid after dispersing a first
liquid, e.g., dispersing resorcin in gelatin, a medical adhesive
such as a fibrin adhesive or the like is used. Additionally, it is
preferable for the adhesive A.sub.h to have quick-drying
properties.
[0177] Further, the puncture needle 116 is removed from the forceps
channel 38, and a bending portion 34 of the insertion section 22 in
the ultrasonic endoscope 12 is bent as shown in FIG. 26.
Furthermore, an inner wall of the intestinal duodenum D is pushed
to move toward the choledoch duct C side. Therefore, outer walls of
the intestinal duodenum D and the choledoch duct C adhere to each
other. Adhesion of the intestinal duodenum D and the choledoch duct
C is observed based on ultrasonic observation. The bent state of
the bending portion 34 is held for a while, e.g., several minutes
to harden the adhesive.
[0178] After hardening the adhesive, a puncture is formed in the
inner side of an edge part of a bonded portion by using a
non-illustrated puncture forceps or the like while confirming the
bonded portion from the inner wall side of the intestinal duodenum
D. Then, as shown in FIG. 27, the choledoch duct C communicates
with the intestinal duodenum D. At this time, since a puncture is
formed in the inner side except the edge part of the portion bonded
by the adhesive, a state where the outer wall of the intestinal
duodenum D is appressed against the outer wall of the choledoch
duct C is held. Moreover, after, e.g., several days, the edge part
of the portion bonded by the adhesive is conglutinated, and a
fistula F is formed between the intestinal duodenum D and the
choledoch duct C.
[0179] Incidentally, when pushing the inner wall of the intestinal
duodenum D to move toward the choledoch duct C side, using the
balloon 134 as shown in FIG. 28 is also preferable. In this case, a
liquid such as water is poured into the balloon 134 through the
balloon duct 132 to inflate the balloon 134, thereby pushing the
wall surface of the intestinal duodenum D by the balloon 134.
Therefore, the wall surface of the intestinal duodenum D is moved
toward the choledoch duct C side, and the outer walls of the
choledoch duct C and the intestinal duodenum D adhere to each
other.
[0180] As described above, according to this embodiment, the
following matters can be said.
[0181] The adhesive is discharged to a space between the two ducts,
the two ducts are caused to adhere to each other by a hardening
function of the adhesive and then a puncture is formed with the
puncture needle, thereby forming a fistula. Since the puncture is
not formed in the choledoch duct C until the intestinal duodenum D
is bonded to the choledoch duct C in this manner, a risk of leakage
of bile into an abdominal cavity from the choledoch duct C is low
as compared with a case where a puncture is formed in the
intestinal duodenum D and the choledoch duct C in a state where
they are separated from each other.
[0182] A third embodiment will now be described with reference to
FIGS. 29 and 30. This embodiment is a modification of the second
embodiment, and like reference numerals denote members equal to
those explained in the second embodiment, thereby omitting a
detailed description thereof.
[0183] An endoscopic system 10 according to this embodiment is
provided with an ultrasonic endoscope 12. As different from the
ultrasonic transducer 122 for ultrasonic observation described in
the second embodiment, an ultrasonic transducer which generates
strong ultrasonic vibration for an ultrasonic treatment with which
a treatment is conducted by a function of ultrasonic waves is
provided in the ultrasonic endoscope 12. A button (a switch) which
vibrates the ultrasonic transducer 122 when performing ultrasonic
observation and a button (not shown) for ultrasonic treatment which
vibrates the ultrasonic transducer which generates strong
ultrasonic vibration are provided to an operation section 24 of the
endoscope 12.
[0184] As described in the second embodiment, a bending portion 34
of an insertion section 22 of the endoscope 12 is used to operate
and bend a curving operation knob 24a of the operation section 24,
and a distal end hard portion 32 of the insertion section 22 pushes
an inner wall of an intestinal duodenum D to move the intestinal
duodenum D toward a choledoch duct C side. Further, in a state
where an outer wall of the intestinal duodenum D is appressed
against an outer wall of the choledoch duct C, the strong
ultrasonic vibration for the ultrasonic treatment different from
that of the ultrasonic transducer 122 for ultrasonic observation is
generated. When the strong ultrasonic vibration is transmitted from
an inner wall of the intestinal duodenum D to the choledoch duct C,
tissues of both organs are heated and denaturalized by the
ultrasonic treatment, and the tissues are caused to adhere to each
other.
[0185] Furthermore, a puncture is formed on an inner side of an
edge part of the united portion by using a non-illustrated puncture
forceps or the like while confirming the united portion from the
inner wall side of the intestinal duodenum D based on optical
observation using the endoscope 12. Then, the choledoch duct C
communicates with the intestinal duodenum D. At this time, since
the puncture is formed on the inner side except the edge part of
the united portion, a state where the outer wall of the intestinal
duodenum D is appressed against the outer wall of the choledoch
duct C is held, thereby forming a fistula.
[0186] It is to be noted that, as described above in the second
embodiment, generating the strong ultrasonic vibration which
enables the ultrasonic treatment from the ultrasonic endoscope 12
is also preferable in order to facilitate adhesion of both organs
after an adhesive A.sub.h is used to bond the outer wall of the
intestinal duodenum D with the outer wall of the choledoch duct C.
That is, after effecting a function shown in FIG. 26 described in
the second embodiment, a function depicted in FIG. 29 is
subsequently carried out. At this time, not only the portion bonded
by the adhesive A.sub.h but also its periphery are caused to
adhere, thereby forming a large fistula without elapse of time.
[0187] Moreover, although the strong ultrasonic vibration for the
ultrasonic treatment can be generated from the ultrasonic endoscope
12 itself in this embodiment, it is also preferable to cause the
intestinal duodenum D to adhere to the choledoch duct C through the
forceps channel 38 by using an energy treatment instrument 162 as
shown in FIG. 30. In this case, an operation of performing adhesion
of several points in a circular shape is repeated. As a result, an
area of adhesion can be increased. When a puncture is formed on the
inner side of the edge part of the bonded portion in this state, a
larger fistula can be formed.
[0188] It is to be noted that, as described in the second
embodiment, generating the strong ultrasonic vibration through the
forceps channel 38 of the ultrasonic endoscope 12 by using the
energy treatment instrument is also preferable in order to
facilitate adhesion of the intestinal duodenum D and the choledoch
duct C after the adhesive A.sub.h is used to bond the outer wall of
the intestinal duodenum D with the outer wall of the choledoch duct
C. That is, after effecting the function shown in FIG. 26 described
in the second embodiment, a function illustrated in FIG. 30 is
carried out. At this time, when not only the portion bonded by the
adhesive A.sub.h but also its periphery are caused to adhere by the
ultrasonic treatment, a larger fistula can be formed.
[0189] A fourth embodiment will now be described with reference to
FIGS. 31 to 45B. This embodiment is a modification of the second
embodiment, and like reference numerals denote members equal to
those explained in the second embodiment, thereby omitting a
detailed description thereof.
[0190] An endoscopic system 10 is provided with an ultrasonic
endoscope 12 and a balloon retaining device 216 depicted in FIG.
31. As described above in the second embodiment, it is also
preferable to use an over-tube in order to aid insertion of an
insertion section 22 of the endoscope 12.
[0191] As shown in FIG. 31, the balloon retaining device 216 is
provided with an outer sheath (a pusher) 222, an inner sheath 224,
an electroconductive needle member 226, a catheter with balloons
228, and an operation section 230. The operation section 230
includes an outer sheath operation section 232 coupled with the
outer sheath 222, an inner sheath operation section 234 coupled
with the inner sheath 224, and a non-electroconductive needle
member operation section 236 coupled with the needle member 226.
Stopper screws 238a and 238b are respectively arranged between the
outer sheath operation section 232 and the inner sheath operation
section 234 and between the inner sheath operation section 234 and
the needle member operation section 236 in order to avoid
operations between these members. It is to be noted that a
connector 236a to/from which a high-frequency power supply which
flows a high-frequency current to the needle member 226 can be
attached/detached is arranged in the needle member operation
section 236.
[0192] The catheter with balloons 228 is detachably arranged on an
outer peripheral surface of a distal end of the inner sheath 224 at
a position of the outer sheath 222 on a distal end side. As shown
in FIGS. 31 and 32, a flange portion 240 protruding toward the
outside in a radial direction is formed at the distal end of the
inner sheath 224. The flange portion 240 is provided with a
plurality of claw portions 240a and slits 240b formed between the
claw portions 240a. As shown in FIGS. 32, 33A and 33B, an impetus
is given to these claw portions 240a toward the inside in the
radial direction (a direction of a central axis of the inner sheath
224). Therefore, when the needle member 226 is arranged at the
distal end of the inner sheath 224, the catheter 228 with balloons
is prevented from coming off the distal end side of the inner
sheath 224. On the other hand, when the needle member 226 is
removed from the distal end of the inner sheath 224, the claw
portions 240a close toward the inside in the radial direction.
Therefore, when the outer sheath 222 is moved forward with respect
to the inner sheath 224, the catheter 228 with balloons comes off
the distal end of the inner sheath 224.
[0193] As shown in FIGS. 34 and 35, the catheter 228 with balloons
includes a cylindrical member 242 and a pair of balloons 244a and
244b. The balloon 244a on the distal end side and the balloon 244b
on the proximal end side are respectively connected with individual
ducts 246a and 246b and separately inflated/deflated. Respective
cocks 248a and 248b are detachably connected with proximal ends of
these ducts 246a and 246b. A syringe 250 can be attached
to/detached from the proximal ends of the ducts 246a and 246b.
[0194] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0195] As described above in the second embodiment, a distal end of
the insertion section 22 of the ultrasonic endoscope 12 is inserted
to reach an intestinal duodenum D. Moreover, a position of a
choledoch duct C is confirmed by using an ultrasonic image.
[0196] The needle member operation section 236 of the balloon
retaining device 216 is moved toward the proximal end side with
respect to the inner sheath operation section 234 so that a
protrusion amount of the distal end of the needle member 226 from
the distal end of the inner sheath 224 is reduced.
[0197] The balloon retaining device 216 is protruded from the
distal end of the insertion section 22 of the endoscope 12 through
the forceps channel 38. Additionally, the needle member operation
section 236 is moved toward a front side with respect to the inner
sheath operation section 234 to protrude the needle member 226 from
the distal end of the inner sheath 224 of the balloon retaining
device 216. Further, this needle member 226 is energized with a
high-frequency current from the connector 236a. Then, a puncture is
formed in wall surfaces of the intestinal duodenum D and the
choledoch duct C. Furthermore, as shown in FIG. 36, the inner
sheath 224 and the catheter with balloons 228 are led to the
choledoch duct C along this puncture. At this time, in particular,
after the syringe 250 is attached at the proximal end of the duct
246a, the cock 248a is opened to pour a gas (air) or a liquid
(water or a normal saline solution) into the balloon 244a on the
distal end side so that the balloon 244a is inflated as shown in
FIG. 37. Moreover, the cock 248a is closed and the syringe 250 is
removed.
[0198] Additionally, the entire balloon retaining device 216 is
pulled toward an operator's hand side. Therefore, the choledoch
duct C is pulled toward the intestinal duodenum D side. Further, as
shown in FIG. 38, the balloon 244b on the proximal end side is
inflated in a state where the balloon 244b on the proximal end side
is arranged in the intestinal duodenum D. At this time, after the
syringe 250 is attached at the proximal end of the duct 246b, the
cock 248b is opened to pour a gas or a liquid into the balloon 244b
on the proximal end side so that the balloon 244b is inflated.
Then, the cock 248b is closed and the syringe 250 is removed.
[0199] Therefore, wall portions of the choledoch duct C and the
intestinal duodenum D are held between the inflated balloons 244a
and 244b on the distal--end side and the proximal end side.
[0200] Furthermore, as shown in FIG. 39, the needle member 226 is
pulled out of the inner sheath 224. Then, the claw portions 240a
dwindle toward the inside along the radial direction. Therefore,
the claw portions 240a are removed from a position facing the
distal end of the cylindrical member 242. Moreover, the inner
sheath 224 and the needle member 226 are removed from the outer
sheath 222. Then, as shown in FIG. 40, the catheter with balloons
228 pierces the wall surface of the intestinal duodenum D and the
wall surface of the choledoch duct C, and the two balloons 244a and
244b hold the wall surface of the intestinal duodenum D and the
wall surface of the choledoch duct C therebetween. Therefore, bile
is discharged from the choledoch duct C into the intestinal
duodenum D through the cylindrical member 242.
[0201] When several days pass in this state, the wall portions of
the choledoch duct C and the intestinal duodenum D held between the
two balloons 244a and 244b are caused to adhere to each other. In a
condition where an adhesion state is stabilized and a fistula is
formed, the balloon 244a on the distal end side is first deflated.
At this time, after the syringe 250 is attached to the duct 246a,
the cock 248a is opened to remove the gas or the liquid from the
balloon 244a on the distal end side, thereby deflating the balloon
244a.
[0202] Additionally, the cylindrical member 242 is pulled toward
the intestinal duodenum D side. Then, the cylindrical member 242 is
taken out to the intestinal duodenum D side, and the fistula F
remains as shown in FIG. 41. Then, the balloon 244b on the proximal
end side is deflated like the balloon 244a on the distal end side,
and the endoscope 12 is used to collect the catheter 228 with
balloons.
[0203] As described above, according to this embodiment, the
following matters can be said.
[0204] The balloon 244a on the distal end side and the balloon 224b
on the proximal end side of the catheter 228 with balloons can hold
the wall surfaces of the intestinal duodenum D and the choledoch
duct C therebetween. Therefore, the fistula can be assuredly formed
by using the cylindrical member 242.
[0205] It is to be noted that the cocks 248a and 248b are
detachably provided in this embodiment as described above, but the
following structure can be adopted in place of the cocks 248a and
248b.
[0206] As shown in FIGS. 42A and 42B, in the catheter 228 with
balloons, the first duct 246a is extended toward the proximal end
side through an inner cavity of the cylindrical member 242. As
shown in FIG. 43, check valves 252a and 252b are arranged at the
proximal ends of the ducts 246a and 246b communicating with the
balloons 244a and 244b on the distal end side and the proximal end
side, respectively. Each of the ducts 246a and 246b is formed to
have such a length as its proximal end is always arranged in the
intestinal duodenum D when forming the fistula between the
intestinal duodenum D and the choledoch duct C.
[0207] When pouring, e.g., a gas (air) or a liquid (a normal saline
solution) into the balloon 244b through the check valve 252b, as
shown in FIG. 44, pouring is performed with a narrow duct 254 being
arranged in the duct 246b. The check valve 252b prevents air or the
normal saline solution from being removed after the balloon 244b is
inflated, thereby maintaining the inflated state.
[0208] In case of deflating the balloon 244b in order to retain the
fistula after formation of the fistula by adhesion, a hole is
formed (a cut is made) in the duct 246b at a position which is
closer to the balloon 244b than the check valve 252b as shown in
FIG. 45A, or the duct 246b including the check valve 252b is cut
off as shown in FIG. 45B. Then, the gas or the normal saline
solution leaks from the balloons 244a and 244b, and the balloons
244a and 244b are deflated. At this time, a hole is made in the
first duct 246a or the first duct 246a is cut off before the second
duct 246b. Furthermore, the balloon 244a on the distal end side is
deflated to pull out the catheter with balloons 228 toward the
intestinal duodenum D side. Thereafter, the balloon 244b on the
proximal end side is likewise deflated and collected by using the
endoscope 12.
[0209] The balloons 244a and 244b can be inflated/deflated with the
end portions of the ducts 246a and 246b of the catheter with
balloons 228 connected with the ducts 246a and 246b having the
check valves 252a and 252b being arranged in a body.
[0210] A fifth embodiment will now be described with reference to
FIGS. 46 to 51. This embodiment is a modification of the fourth
embodiment, and like reference numerals denote members equal to
those described in the fourth embodiment, thereby omitting a
detailed explanation thereof.
[0211] As shown in FIG. 46, a balloon retaining device 216 is
provided with an outer sheath 222, an inner sheath 224, a needle
member 226, a catheter 228 with balloons and an operation section
230 like the fourth embodiment. A distal end side of the inner
sheath 224 is formed into a thin-walled shape, and a proximal end
side of the same is formed into a thick-walled shape through a
step. The catheter with balloons 228 is detachably arranged on an
outer peripheral surface of the thin-walled part of the inner
sheath 224 on the distal end side at a position of a distal end
side of the outer sheath 222.
[0212] As shown in FIGS. 47A and 47B, the catheter 228 with
balloons includes a first cylindrical member 262a, a second
cylindrical member 262a and first and second balloons 244a and
244b. The first balloon 244a is arranged on an outer peripheral
surface at a distal end of the first cylindrical member 262a. A
first ratchet portion 264a is formed on an outer peripheral surface
at a proximal end of the first cylindrical member 262a.
[0213] The second balloon 244b is arranged on an outer peripheral
surface at a distal end of the second cylindrical member 262b. A
second ratchet portion 264b which can be engaged with the first
ratchet portion 264b is formed on an inner peripheral surface at
the distal end of the second cylindrical member 262b. The outer
sheath 222 is arranged on the proximal end side of this second
cylindrical member 262b. The outer sheath 222 is relatively movable
with respect to the inner sheath 224. Therefore, the proximal end
of the second cylindrical member 262b can be pushed toward the
distal end side. Accordingly, movement of the outer sheath 222 with
respect to the inner sheath 224 can increase/reduce a distance
between the first balloon 244a and the second balloon 244b.
Moreover, since the first ratchet portion 264a and the second
ratchet portion 264b are ratchet-engaged with each other, they are
fixed at arbitrary positions in an axial direction.
[0214] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0215] A distal end of an insertion section 22 of the ultrasonic
endoscope 12 is inserted to reach an intestinal duodenum D.
Additionally, a position of a choledoch duct C is confirmed by
using an ultrasonic image.
[0216] A needle member operation section 236 of the balloon
retaining device 216 is moved toward the proximal end side with
respect to an inner sheath operation section 234 to reduce a
protruding amount of the distal end of the needle member 226 from
the distal end of the inner sheath 224.
[0217] The balloon retaining device 216 is protruded from the
distal end of the insertion section 22 of the endoscope 12 through
a forceps channel 38. Further, the needle member 226 is protruded
from the distal end of the balloon retaining device 216, and the
needle member 226 is energized with a high-frequency current. Then,
a puncture is formed in wall surfaces of the intestinal duodenum D
and the choledoch duct C. Furthermore, as shown in FIG. 48, the
inner sheath 224 and the catheter with balloons 228 are led to the
choledoch duct C along this puncture. At this time, as shown in
FIG. 49, in particular, the first balloon 244a on the distal end
side is inflated by pouring a gas or a liquid through the duct
246a.
[0218] Moreover, the entire balloon retaining device 216 is pulled
in toward an operator's hand side. Therefore, the choledoch duct C
is pulled in toward the intestinal duodenum D side. Additionally,
as shown in FIG. 50, the balloon 244b on the proximal end side is
inflated in a state where the balloon 244b on the proximal end side
is arranged in the intestinal duodenum D. Therefore, the wall
portions of the choledoch duct C and the intestinal duodenum D are
arranged between the first balloon 244a on the distal end side and
the second balloon 244b on the proximal end side.
[0219] Further, the outer sheath 222 is moved forward with respect
to the inner sheath 224. Then, the second balloon 244b of the
second cylindrical member 262b moves closer to the first balloon
244a of the first cylindrical member 262a while effecting ratchet
engagement. Therefore, as shown in FIG. 51, the wall portions of
the choledoch duct C and the intestinal duodenum D are held between
the first balloon 244a on the distal end side and the second
balloon 244b on the proximal end side by an approach of the
inflated first and second balloons 244a and 244b.
[0220] Subsequently, the needle member 226 is removed from the
inner sheath 224. Then, claw portions 240a dwindle toward the
inside along a radial direction. Therefore, the claw portions 240a
are removed from a position facing the distal end of the first
cylindrical member 262a. Further, the inner sheath 224 is removed
from the outer sheath 222. Then, the catheter with balloons 228
pierce the wall surface of the intestinal duodenum D and the wall
surface of the choledoch duct C, and the wall surface of the
intestinal duodenum D and the wall surface of the choledoch duct C
are held between the two balloons 244a and 244b. Therefore, bile is
discharged into the intestinal duodenum D from the choledoch duct C
through the first cylindrical member 262a.
[0221] When several days pass in this state, the wall portions of
the choledoch duct C and the intestinal duodenum D held between the
two balloons 244a and 244b are caused to adhere to each other. In a
state where an adhesion condition is stabilized and a fistula is
formed, the balloon 244a on the distal end side is first deflated.
Furthermore, the first and second cylindrical members 262a and 262b
are pulled toward the intestinal duodenum D side. Then, the first
and second cylindrical members 262a and 262b are taken out to the
intestinal duodenum D side, and the fistula remains. Moreover, the
balloon 244b on the proximal end side is also deflated, and the
catheter with balloons 228 is collected through the endoscope
12.
[0222] A subsequent function is the same as that described in
conjunction with the fourth embodiment. Therefore, a description on
the effect will be omitted.
[0223] As mentioned above, according to this embodiment, the
following matters can be said.
[0224] A large distance between the balloon 244a on the distal end
side and the balloon 244b on the proximal end side can be assured.
That is, it is possible to readily take a state where the wall
surfaces of the intestinal duodenum D and the choledoch duct C are
arranged between the inflated balloon 244a on the distal end side
and the inflated balloon 244b on the proximal end side. Thereafter,
the balloon 244b on the proximal end side is moved closer to the
balloon 244a on the distal end side, thereby assuredly holding the
wall surfaces of the intestinal duodenum D and the choledoch duct
C. Accordingly, the intestinal duodenum D can be assuredly
appressed against the choledoch duct C and the fistula can be more
securely formed.
[0225] A sixth embodiment will now be described with reference to
FIGS. 52 and 53. This embodiment is a modification of the fourth
embodiment, and like reference numerals denote members equal to
those explained in the fourth embodiment, thereby omitting a
detailed description thereof.
[0226] As shown in FIG. 52, a third balloon 244c is arranged
between a first balloon 244a on a distal end side and a second
balloon 244b on a proximal end side. As depicted in FIG. 53, this
third balloon 244c is formed in such a manner that its maximum
external diameter becomes smaller than a maximum external diameter
of each of the first and second balloons 244a and 244b.
[0227] Here, as described above, the first and second balloons 244a
and 244b are used to hold wall surfaces of a choledoch duct C and
an intestinal duodenum D therebetween. Therefore, the third balloon
244c between the first and second balloons 244a and 244b is used to
increase a fistula. According to this structure, inflating the
third balloon 244c can increase an opening diameter of the
fistula.
[0228] A seventh embodiment will now be described with reference to
FIGS. 54A to 59. This embodiment is a modification of the second
embodiment, and like reference numerals denote members equal to
those explained in the second embodiment, thereby omitting a
detailed description.
[0229] An endoscopic system 10 is provided with an electronic
convex type ultrasonic endoscope 12 and a puncture needle 116 for
ultrasonic observation (see FIG. 22). As shown in FIGS. 54A and 55,
a side hole 312 is formed in a needle tube 146 of this puncture
needle 116 along its longitudinal axis direction. As shown in FIGS.
54A and 54B, a magnet (a first magnet) 322 with a cord-like member
324 is arranged in the needle tube 146 to be detachable from the
side hole 312. This magnet 322 has a supporting point portion 326
formed on an outer peripheral surface at a distal end thereof. This
supporting point portion 326 is brought into contact with a distal
end of the side hole 312 and can swivel with the distal end of the
side hole 312 as a supporting point. On the other hand, the magnet
322 has an inclined surface portion 328 at a proximal end on a side
facing a proximal end of the side hole 312. This inclined surface
portion 328 is formed in such a manner that the magnet 322 can be
readily discharged to the outside while swiveling with the
supporting point portion 326 as the supporting point when a distal
end of a stylet 148 which can be freely inserted/removed is brought
into contact with the inclined surface portion 328. That is, the
inclined surface portion 328 is a part which exercise a force when
causing the magnet 322 to drop off the side hole 312 with the
supporting point portion 326 serving as the supporting point.
[0230] It is to be noted that a later-described second magnet 330
carried into a body cavity by the endoscope 12 is formed to have an
area covering the largest surface of a plurality of surfaces of the
first magnet 322.
[0231] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0232] A distal end of an insertion section 22 of the ultrasonic
endoscope 12 is inserted to reach an intestinal duodenum D.
Further, a position of a choledoch duct C is confirmed by using an
ultrasonic image.
[0233] The needle tube 146 of the puncture needle 116 for
ultrasonic observation from which the stylet 148 has been removed
pierces the intestinal duodenum D and the choledoch duct C.
Furthermore, the stylet 148 is put in the needle tube 146, and the
inclined surface portion 328 of the magnet 322 is pushed by the
distal end of the stylet 148. Then, as shown in FIG. 56, the magnet
322 swivels to be discharged to the outside of the needle tube 146
by the supporting point portion 326 of the magnet 322. At this
time, a proximal end of a cord-like member 324 coupled with the
magnet 322 remains on the intestinal duodenum D side while
maintaining a state where the cord-like member 324 pierces the
intestinal duodenum D and the choledoch duct C. Moreover, the
needle tube 146 is pulled out of the intestinal duodenum D and the
choledoch duct C, and the puncture needle 116 for ultrasonic
observation is pulled out of a forceps channel 38 of the endoscope
12.
[0234] Additionally, as shown in FIG. 57, a treatment instrument (a
straight grasping forceps) 332 grasping the second magnet 330 at a
distal end thereof is newly introduced into the intestinal duodenum
D from the forceps channel 38. Further, existence of the cord-like
member 324 coupled with the first magnet 322 is recognized based on
optical observation using the endoscope 12.
[0235] When the second magnet 330 is arranged in the intestinal
duodenum D, the first magnet 322 and the second magnet 330 attract
each other by magnet attraction forces. Therefore, as shown in FIG.
58, outer walls of the choledoch duct C and the intestinal duodenum
D are appressed against each other by functions of the first and
second magnets 322 and 330. At this time, positions of the magnets
322 and 330 can be adjusted by operating the cord-like member 324
coupled with the first magnet 322. Furthermore, a part held between
the first magnet 322 and the second magnet 330 undergoes ischemia
due to compression by attraction forces of the magnets 322 and 330.
When such ischemia lasts long, a tissue of this part becomes
necrotic. At this time, since an area of the second magnet 330 is
larger than that of the first magnet 322 and only a part where the
first magnet 322 is appressed against the inner wall of the
choledoch duct C is compressed, a tissue of this part become
necrotic.
[0236] Moreover, a fistula F is formed in this necrotic part. At
this time, since the second magnet 330 is formed to have a larger
area than that of the first magnet 322, the first magnet 322 passes
through the fistula F, but the second magnet 330 cannot pass
through the fistula F. Therefore, as shown in FIG. 59, the first
and second magnets 322 and 330 fall off on the intestinal duodenum
D side in a state where they exert magnet attraction forces on each
other (they are attracted to each other). Additionally, the
choledoch duct C and the intestinal duodenum D are caused to adhere
to each other, thereby maintaining the fistula F.
[0237] It is to be noted that the cord-like member 324 is coupled
with the first magnet 322, and hence the first and second magnets
322 and 330 which has fallen off are caught in the intestinal
duodenum D. Therefore, the cord-like member 324 which has been
inserted into the forceps channel 38 of the endoscope is pulled
toward the intestinal duodenum D in order to remove the cord-like
member 324 from the wall surfaces of the choledoch duct C and the
intestinal duodenum D. Further, in this state, the endoscope 12 is
used to collect the magnets 322 and 330 or drop them in the
intestinal duodenum D to be discharged.
[0238] As described above, according to this embodiment, the
following matters can be said.
[0239] Since the first magnet 322 is formed to be smaller than the
second magnet 330, a part which becomes necrotic due to ischemia
can be restricted to a region in which the first magnet 322 is
appressed against the choledoch duct C. Therefore, the second
magnet 330 can be prevented from falling off on the choledoch duct
C side.
[0240] An eighth embodiment will now be described with reference to
FIGS. 60 to 76. This embodiment is a modification of the seventh
embodiment, and like reference numerals denote members equal to
those explained in the seventh embodiment, thereby omitting a
detailed description thereof.
[0241] As shown in FIG. 60, an endoscopic system 10 is provided
with an electronic convex type ultrasonic endoscope 12 and a magnet
assembly retaining device 416.
[0242] As shown in FIG. 61, the magnet assembly retaining device
416 includes an outer sheath 422, a pusher (an inner sheath) 424,
an operation section 426, and a wire 428 having a hook 428a at a
distal end thereof. The outer sheath 422, the pusher 424 and the
wire 428 have flexibility so that they are bent in accordance with
bending of an insertion section 22 of the endoscope 12 when they
are inserted into a forceps channel 38 of the endoscope 12. The
pusher 424 is formed of, e.g., a coil consisting of a metal
material.
[0243] The operation section 426 is provided with an operation
section main body 432 and a slider (a hook operation section) 434
which can slide with respect to this operation section main body
432. The tubular pusher 424 is fixed at a distal end of the
operation section main body 432. The outer sheath 422 is arranged
on an outer periphery of the pusher 424. The wire 428 is inserted
into the pusher 424, and a proximal end of the wire 428 is fixed to
the slider 434.
[0244] A magnet assembly 440 shown in FIGS. 62A and 62B is arranged
on a hook 428a at the distal end of the wire 428. As illustrated in
FIGS. 62A and 62B, the magnet assembly 440 is provided with a
loop-shaped cord-like member 442, a plurality of magnets 444
aligned by this cord-like member 442, and a stopper 446 which
prevents the magnets 444 from falling off the cord-like member 442.
As shown in FIG. 62B, the magnet assembly 440 forms a substantially
circular shape when the magnets 444 adjacent to each other move
along the cord-like member 442 to be magnetically attached to each
other.
[0245] The stopper 446 moves along the cord-like member 442 to
change a size of a loop-shaped part of the cord-like member 442.
This stopper 446 is engaged with the cord-like member 442 by a
frictional force. It is to be noted that the stopper 446 is formed
of, e.g., a silicone rubber material.
[0246] As shown in FIGS. 63A and 63B, as the magnet 444, a magnet
having one of various kinds of shapes such as a discoid shape, a
rectangular board shape or the like is used. Further, a square
shape (a space except a circular space) into which the cord-like
member 442 is inserted is formed at the center of the magnet 444
shown in FIG. 63B. On the other hand, a lateral cross section of
the cord-like member 442 combined with the magnet 444 depicted in
FIG. 63B is formed into, e.g., a rectangular shape (formed into a
shape other than a circular shape). Therefore, each magnet 444 is
prevented from rotating in a periaxial direction of the cord-like
member 442. Furthermore, when each magnet is formed to have a
bulging shape on a distal end surface side and a proximal end
surface side as shown in FIG. 64A, the magnets 444 can be curved in
an appropriate direction in a state where coupling of the magnets
444 is maintained as shown in FIG. 64B.
[0247] Moreover, as illustrated in FIG. 65, it is preferable for
each magnet 444 to be formed into such a shape as a string or an
arc (a circumference) on an inner peripheral side is shorter than a
string or an arc (a circumference) on an outer peripheral side in
such a manner that a circular shape is formed when the plurality of
magnets 444 adjacent to each other are magnetically attached to
each other. In this case, when the stopper 446 is moved toward the
distal end side of the cord-like member 442 to magnetically attach
the magnets 444 to each other, the circular shape is gradually
formed. Therefore, the magnet assembly 440 is rounded into a
substantially circular shape. Moreover, appropriately setting a
ratio of the string on the inner peripheral side and the string on
the outer peripheral side can define a diameter of a magnet group
describing a circular shape.
[0248] A function of the magnet assembly retaining device 416
according to this embodiment will now be explained. Here, a
description will be given as to a case where the magnet assembly
440 shown in FIGS. 62A and 62B is used.
[0249] First, as shown in FIG. 66A, the magnet assembly 440 is
previously arranged in a state where it is retracted into the
distal end of the outer sheath 422 of the magnet assembly retaining
device 416. At this time, the plurality of magnets 444 are aligned
in a straight line by the cord-like member 442.
[0250] As shown in FIG. 66B, when the outer sheath 422 of the
magnet assembly retaining device 416 is pulled with respect to the
pusher 424, the distal end of the cord-like member 442 and the
stopper 446 of the magnet assembly 440 are moved to the outside. In
this state, the slider 434 is operated with respect to the
operation section main body 432 depicted in FIG. 61 to pull the
wire 428 toward an operator's hand side. Then, the cord-like member
442 is pulled in toward the operator's hand side by the hook 428a.
Therefore, as shown in FIG. 66C, the stopper 446 relatively moves
forward and the loop of the cord-like member 442 on the distal end
side is narrowed. In this state, the slider 434 shown in FIG. 61 is
operated to move the wire 428 toward the distal end side. Then, the
hook 428a protrudes from the distal end of the pusher 424.
Therefore, as shown in FIG. 66D, engagement between the hook 428a
and the loop-shaped cord-like member 442 is released so that the
magnet assembly 440 is separated from the magnet assembly retaining
device 416.
[0251] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0252] The distal end of the insertion section 22 of the ultrasonic
endoscope 12 is inserted to reach an intestinal duodenum D.
Additionally, a position of a choledoch duct C is confirmed based
on an ultrasonic image.
[0253] A puncture needle 116 (see FIG. 22) described in the second
embodiment is used in the forceps channel 38 of the endoscope 12 to
form holes H.sub.1 and H.sub.2 in the choledoch duct C from the
intestinal duodenum D in advance.
[0254] As shown in FIG. 67, the distal end of the outer sheath 422
of the magnet assembly retaining device 416 is led into the
choledoch duct C through the holes H.sub.1 and H.sub.2 formed by
using the puncture needle (not shown). Further, as described above,
the magnet assembly 440 is separated from the magnet assembly
retaining device 416. That is, as shown in FIG. 68, the magnet
assembly 440 is discharged into the choledoch duct C. Furthermore,
the magnet assembly retaining device 16 is removed from the forceps
channel 38.
[0255] Thereafter, a second magnet having an external diameter
larger than that formed by the magnet group having a circular shape
in the magnet assembly 440 is introduced into the duodenum D
through the forceps channel 38 (see FIG. 57). Then, as shown in
FIG. 69, the magnet assembly 440 is appressed against the second
magnet 330 through a wall surface of the choledoch duct C and a
wall surface of the intestinal duodenum D. Therefore, the
intestinal duodenum D becomes appressed against the choledoch duct
C.
[0256] As described above, according to this embodiment, the
following matters can be said.
[0257] When the plurality of magnets 444 in the magnet assembly 440
are combined to form an annular shape or the like, an area
undergoing ischemia can be increased. Furthermore, even if the
inside of the annular part is not compressed by a function of the
magnets 444, a blood flow can be stopped, thereby effecting an
ischemic event. Therefore, a part which becomes necrotic can be
formed into an annular shape, thereby forming a larger fistula.
[0258] It is to be noted that, as shown in FIG. 70, the magnet
assembly 440 in which the magnets 444 have an annular shape is used
as the first magnet and the annular second magnet 330 is utilized.
Moreover, the puncture needle (see FIG. 22) pierces the inside of
both the annular second magnet 330 and the annular magnets 444 in
the magnet assembly (the first magnet) at a time, for example.
Then, a fistula is formed, and bile can be immediately discharged
without waiting for opening due to necrosis of a tissue.
[0259] Although the description has been given as to the case where
the loop-shaped cord-like member 442 is used in this embodiment,
but it is also preferable to use the linear cord-like member 452 in
order to align the magnets 444 in a straight line as shown in FIG.
71. In this case, a ring 452a which is caught on the hook 428a is
formed at the proximal end of the cord-like member 452.
Additionally, a distal end stopper 452b having, e.g., a spherical
shape which prevents the magnets 444 from falling from the distal
end of the cord-like member 452 is arranged at the distal end of
the cord-like member 452. Further, a proximal end stopper 452c
which prevents the magnets 444 from falling from the proximal end
side and defines a movable range of the magnets 444 in cooperation
with the distal end stopper 452 is arranged between the distal end
stopper 452b and the ring 542a. It is to be noted that using a
stopper which is movable along the cord-like member 452 (see FIG.
72A) as the proximal end stopper 452c is also preferable.
[0260] Furthermore, as the magnet 444 used in the magnet assembly
440 shown in FIGS. 72A and 72B, one which is the same as that
depicted in FIG. 65 is utilized. Therefore, when the stopper 446 is
moved toward the distal end side of the cord-like member 452 from
the state shown in FIG. 72A, the magnets 444 adjacent to each other
are magnetically attached to each other to form a circular shape as
illustrated in FIG. 72B.
[0261] Moreover, as shown in FIG. 72C, a part of the magnet 444
which is closest to the stopper 446 and into which the cord-like
member 444 is inserted is bent. Therefore, the stopper 446 can be
prevented from entering a space between the magnets 444 (see FIG.
72B). That is, when the cord-like member 452 which is inserted into
the magnet 444 closest to the stopper 446 is extended from a
surface of the magnet 444 on the outer peripheral side, the stopper
446 can be prevented from being arranged between the magnets 444.
Then, a shape which is further close to the circular shape can be
obtained when the plurality of magnets 444 are magnetically
attached to each other.
[0262] It is to be noted that a magnetic force equivalent to that
of a large C-shaped magnet can be obtained when magnets 456 shown
in FIG. 73A and non-magnetic bodies (spacers) 458 illustrated in
FIG. 73B are aligned as depicted in FIG. 73C. That is, the small
magnets 456 can be collected to increase a magnetic force. This
magnet assembly 440 is used like one shown in FIGS. 66A to 66D.
Therefore, even if each magnet 456 has a small magnetic force and a
small size, it is possible to obtain the magnet assembly 440 having
an appropriately adjustable size and a settable magnetic force
intensity.
[0263] When rod-like magnets 462 shown in FIG. 74A are magnetically
attached to each other as depicted in FIG. 74B, as shown in FIG.
74C, the magnet assembly 440 becomes substantially equivalent to
one magnet having a magnetic force corresponding to that of the two
magnets 462 depicted in FIG. 74A. Therefore, coupling the small
magnets 462 with each other while maintaining a predetermined
direction and a positional relationship can obtain the same effect
as that of retaining a large magnet through a narrow duct or a
stenosis part.
[0264] It is to be noted that the description has been given as to
the case where a puncture is formed in respective wall surfaces
from one duct (the first duct) to the other duct (the second duct)
to discharge the magnet assembly 440 into the choledoch duct C in
this embodiment, but there are several methods to realize this
embodiment.
[0265] As shown in FIG. 75, for example, the endoscope 12 is
operated to introduce the distal end of the magnet assembly
retaining device 416 into the choledoch duct C from a papilla P of
the intestinal duodenum D. Then, the magnet assembly retaining
device 416 is operated to discharge the magnet assembly 440 into
the choledoch duct C. Thereafter, likewise, the second magnet 330
is led into the intestinal duodenum D. Therefore, the magnets 444
in the magnet assembly 440 are magnetically attached to the second
magnet 330 in the intestinal duodenum D.
[0266] In order to discharge the magnet assembly 440 into the
choledoch duct C, there is another method.
[0267] FIG. 76 shows percutaneous transhepatic cholangial drainage
(PCTD). This is a method of discharging bile from a tube 466
arranged in the choledoch duct C through a body wall W of an
abdominal region from the outside of a body.
[0268] The magnet assembly retaining device 416 is inserted into
the tube 466 to discharge the magnet assembly 440 into the
choledoch duct C. Furthermore, the insertion section 22 of the
endoscope 12 is introduced into the intestinal duodenum D through a
mouth, and the second magnet 330 is magnetically attached to the
magnets 444 in the magnet assembly 440.
[0269] A ninth embodiment will now be described with reference to
FIGS. 77A to 83G. This embodiment is a modification of the eighth
embodiment, and like reference numerals denote members equal to
those explained in the eighth embodiment, thereby omitting a
detailed description thereof.
[0270] As shown in FIG. 77A, a magnet assembly retaining device 416
is provided with a sheath 472, a pusher 474 and an operation
section 476. The operation section 476 includes an operation
section main body 482 and a slider 484 which can slide along the
operation section main body 482.
[0271] As shown in FIGS. 77A and 77B, the sheath 472 is provided
with two lumens (a double lumen) 486a and 486b having two different
internal diameters. The pusher 474 is arranged in the first lumen
486a having a larger internal diameter in a state where the pusher
474 is coupled with the slider 484 of the operation section 476. A
cord-like member 452 is inserted into the second lumen 486b having
a smaller internal diameter than that of the first lumen 486a.
Moreover, a side hole 488 from which a proximal end side of the
cord-like member 452 is extended to the outside of the magnet
assembly retaining device 416 is formed at a proximal end of the
second lumen 486b.
[0272] As shown in FIG. 78, a magnet assembly 440 is arranged in
the magnet assembly retaining device 416. Magnets 492, a distal end
stopper 494, a rear end stopper 496 and spacers 498 are arranged in
the first lumen 486a of the magnet assembly retaining device 416 in
a state where the cord-like member 452 is inserted in these
members. Additionally, a distal end of the pusher 474 is in contact
with the rear end stopper 496. It is to be noted that the cord-like
member 452 connects the first lumen 486a with the second lumen 486b
through the distal end of the sheath 472. The distal end stopper
494 is temporarily fixed to the sheath 472 (the first lumen 486a)
in a state where the distal end stopper 494 is pulled in toward the
proximal end side of the sheath 472 apart from the distal end of
the same. Therefore, as will be described later, temporary fixation
of the distal end stopper 494 with respect to the sheath 472 can be
readily released.
[0273] As shown in FIG. 79, a through hole 492a into which the
cord-like member 452 is inserted along a direction connecting an S
pole with an N pole is formed in the magnet 492. Furthermore, an
edge of one end (a left end in FIG. 79) of the through hole 192a of
the magnet 492 is formed into a tapered shape. That is, one end of
the through hole 492a of each magnet 492 is formed into a counter
boring shape.
[0274] As shown in FIG. 80A, a though hole 494a into which the
cord-like member 452 can be inserted is formed in the distal end
stopper 494 arranged on the distal end side of the plurality of
magnets 492. A wedge-like member 494b shown in FIG. 80B is arranged
at one end (a left end in FIG. 80A) of the through hole 494a, and
this member bites into one end of the through hole 494a when a
large force is applied thereto. Therefore, the distal end stopper
494 and the wedge-like member 494b are formed of such materials as
the wedge-like member 494b bites into the distal end stopper 494.
It is to be noted that the distal end stopper 494 is formed into a
shape with which the distal end stopper 494 can be inserted into
the first lumen 486a but cannot be inserted into the second lumen
486b in order to avoid entering the second lumen 486b from the
distal end side of the sheath 472.
[0275] As shown in FIG. 81A, a through hole 496a into which the
cord-like member 452 can be inserted is formed in the proximal end
stopper 496 arranged on the proximal end side of the plurality of
magnets 492. A wedge-like member 496b shown in FIG. 81B is arranged
at one end (a right end in FIG. 81A) of this through hole 496a, and
this member bites into the one end of the through hole 496a when a
large force is applied thereto. Therefore, the proximal end stopper
496 and the wedge-like member 496b are formed of such materials as
the wedge-like member 496b bites into the proximal end stopper 496.
It is to be noted that the proximal end stopper 496 fixes the
cord-like member 452 inserted into the through hole 496a.
[0276] As shown in FIG. 78, each spacer 498 shown in FIG. 82 is
arranged between the magnets 492 adjacent to each other. A through
hole 498a into which the cord-like member 452 can be inserted is
formed in the spacer 498. The spacer 498 is formed of a flexible
silicone resin material. When each spacer 498 is strongly pushed
into a space between the magnets 492, it enters the tapered
(counter-boring-like) edge of the magnet 492 shown in FIG. 79.
[0277] A function of the endoscopic system 10 according to this
embodiment will now be described.
[0278] As shown in FIG. 83A, the distal end of the sheath 472 of
the magnet assembly retaining device 416 is arranged in the
choledoch duct C. Moreover, the pusher 474 is pushed in toward the
distal end side of the sheath 472. Then, temporary fixation between
the distal end stopper 494 an the sheath 472 is released and the
distal end stopper 494 protrudes with respect to the distal end of
the sheath 472.
[0279] As shown in FIG. 83B, the cord-like member 452 on the second
lumen 486b side is strongly pulled toward an operator's hand side.
Then, the distal end stopper 494 does not enter the second lumen
486b from the distal end side of the sheath 472, but is temporarily
fixed at the distal end of the sheath 472. Therefore, as shown in
FIG. 83C, a distance between the proximal end stopper 496 and the
distal end stopper 494 is reduced. That is, each spacer 498 enters
the tapered edge of the through hole 492a of each magnet 492, and
the magnets 492 adjacent to each other are magnetically attached to
each other as shown in FIG. 83D. At this time, as described above,
the magnets 492 become equivalent to a large magnet having the S
pole and the N pole (see FIG. 83E). Additionally, when the
cord-like member 452 is pulled to apply a pressure, the wedge-like
members 494b and 496b of the distal end stopper 494 and the rear
end stopper 496 bite into the distal end stopper 494 and the rear
end stopper 496, respectively. Therefore, a distance of the
cord-like member 452 between the distal end stopper 494 and the
rear end stopper 496 is fixed.
[0280] As shown in FIG. 83F, the pusher 474 is pushed in toward the
distal end side of the sheath 472 to move the integrated magnets
492 to the outside from the distal end of the sheath 472.
[0281] As shown in FIG. 83G, the pusher 474 and the sheath 472 are
removed to the operator's hand side. Therefore, the magnets fixed
to the cord-like member 452 are retained in the choledoch duct C.
It is to be noted that, when a length of the cord-like member 452
is too long, this member can be, e.g., cut to adjust its
length.
[0282] In this state, like the seventh embodiment, a biomedical
tissue is necrotized, and a fistula is formed between the choledoch
duct C and the intestinal duodenum D. Further, after formation of
the fistula, the magnets 492 fall in the intestinal duodenum D
together with the cord-like member 452. As described above,
according to this embodiment, the following matters can be
said.
[0283] Since the spacers 498 prevent the magnets 492 from being
magnetically attached to each other when inserting the magnet
assembly retaining device 416 into the forceps channel 38 of the
endoscope 21, the magnet assembly retaining device 416 can be
readily inserted along a shape of a body cavity.
[0284] Furthermore, when the magnets 492 having a small magnetic
force are coupled with each other, they can be used as a large
magnet having a large area and a large magnetic force.
[0285] Therefore, at the time of insertion into the forceps channel
38 of the endoscope 12, since the respective magnets 492 are
separated from each other through the spacer 498, insertion is
facilitated. When the magnets are discharged into the choledoch
duct C, they can be discharged as a large magnet having a large
magnetic force and size.
[0286] A 10th embodiment will now be described with reference to
FIGS. 84 to 85E. This embodiment is a modification of the ninth
embodiment, and like reference numerals denote members equal to
those explained in the ninth embodiment, thereby omitting a
detailed description thereof.
[0287] A magnet assembly retaining device 416 shown in FIG. 84 is
formed with one lumen (a single lumen) as different from the sheath
472 described in the ninth embodiment.
[0288] As shown in FIGS. 85A to 85C, in a magnet assembly 440,
spacers 498 which readily fall off a cord-like member 452 and are
formed of a biocompatible material are arranged between magnets
492. Therefore, as the magnets 492 protrude from a distal end of a
sheath 472, the spacers 498 fall off and the magnets 492 adjacent
to each other are magnetically attached to each other.
[0289] It is to be noted that, in this embodiment, a distal end
stopper 494 and the cord-like member 452 are fixed to each other as
different from the ninth embodiment, but a proximal end stopper 496
is movable with respect to the cord-like member 452.
[0290] A function of an endoscopic system 10 according to this
embodiment will now be described.
[0291] As shown in FIG. 85A, a distal end of the sheath 472 of the
magnet assembly retaining device 416 is arranged in a choledoch
duct C through an intestinal duodenum D.
[0292] As shown in FIG. 85B, a pusher 474 is moved to the distal
end side of the sheath 472. A distal end stopper 494 and magnets
492 protrude from the distal end of the sheath 472. Then, the
spacer 498 falls from a space between the magnets 492. Therefore,
as shown in FIG. 85C, the magnets 492 adjacent to each other are
magnetically attached to each other.
[0293] Further, the magnets 492 adjacent to each other are
sequentially magnetically attached to each other with fall of each
spacer 498. Furthermore, the pusher 474 is moved forward to engage
and fix a wedge-like member of the proximal end stopper 496 with
respect to the cord-like member 452. Therefore, as shown in FIG.
85D, the plurality of magnets 492 are magnetically attached to each
other to become equivalent to one magnet having a large magnetic
force.
[0294] Moreover, as shown in FIG. 85E, in a state where the magnets
492 are arranged in the choledoch duct C, the sheath 472 and the
pusher 474 are removed. The fallen spacers 498 are formed of a
bioabsorbable material and eventually absorbed into a body, and
hence they do not remain in the choledoch duct C.
[0295] As described above, according to this embodiment, the
following matters can be said.
[0296] Since the sheath 472 with the single lumen is used in the
magnet assembly retaining device 416, a diameter of the sheath 472
in the magnet assembly retaining device 416 can be reduced to be
smaller than that of the sheath with the double lumen.
[0297] It is to be noted that the description has been given as to
the case where the intestinal duodenum D is anastomosed with the
choledoch duct C in this embodiment, but a stomach S can be
anastomosed with a jejunum J. In this case, since each spacer 498
can be directly discharged into the jejunum J, it does not have to
be formed of a bioabsorbable material.
[0298] An 11th embodiment will now be described with reference to
FIGS. 86 to 87B. This embodiment is a modification of the 10th
embodiment, and like reference numerals denote members equal to
those explained in the 10th embodiment, thereby omitting a detailed
description thereof.
[0299] As shown in FIG. 86, first and second cord-like members 454a
and 454b are arranged in a sheath 472 of a magnet assembly
retaining device 416.
[0300] As shown in FIGS. 87A and 87B, the first cord-like member
454a is inserted into magnets 492, a distal end stopper 494, a rear
end stopper 496 and a pusher 474. A plurality of spacers 498 are
fixed at a distal end of the second cord-like member 454b at
predetermined intervals. Therefore, a proximal end of the second
cord-like member 454b can be grasped on an operator's hand side to
readily collect the fallen spacers 498.
[0301] According to the above description, the following items can
be obtained.
[0302] Item 1. A fistulectomy method of forming a fistula between a
first duct and a second duct, comprising:
[0303] sticking a puncture needle into the second duct from the
inside of the first duct through a wall surface of the first duct
and a wall surface of the second duct;
[0304] arranging the puncture needle at a position of a central
axis and sticking a coil around the puncture needle from the first
duct toward the second duct to couple the first duct with the
second duct;
[0305] maintaining the coil needle in a state where the first duct
communicates with the second duct; and
[0306] forming a fistula on an inner side of the coil needle.
[0307] Item 2. The fistulectomy method according to Item 1, further
comprising:
[0308] arranging an over-tube on an outer periphery of an insertion
section of an endoscope to lead the coil needle to the first duct
in a state where a proximal end of the coil needle is engaged with
a distal end of the over-tube.
[0309] Item 3. The fistulectomy method according to Item 2, further
comprising:
[0310] rotating the over-tube in a periaxial direction thereof when
releasing engagement between the over-tube and the coil needle.
[0311] Item 4. An ultrasonic endoscope comprising:
[0312] an elongated insertion section having a distal end and a
proximal end; and
[0313] an operation section provided at the proximal end of the
insertion section,
[0314] wherein the insertion section includes on a distal end
surface of the distal end a distal end hard portion having an
ultrasonic transducer, a forceps channel opening portion and an
object lens in a straight line.
[0315] Item 5. The ultrasonic endoscope according to Item 4,
wherein the forceps channel opening portion is arranged on a
central axis of the distal end hard portion, and
[0316] central axes of the ultrasonic transducer and the object
lens are placed at substantially symmetrical positions with respect
to the central axis of the distal end hard portion.
[0317] Item 6. A fistulectomy method of forming a fistula between a
first duct and a second duct, comprising:
[0318] sticking a puncture needle from the inside of the first duct
toward the outside of the second duct;
[0319] discharging an adhesive from the puncture needle to a space
between the first duct and the second duct;
[0320] relatively moving the first duct and the second duct closer
to each other to attach outer wall surfaces of these ducts to each
other by using the adhesive; and
[0321] forming a fistula on an inner side of an edge of a part
where the outer wall surfaces are attached to each other.
[0322] Item 7. The fistulectomy method according to Item 6, further
comprising:
[0323] using an ultrasonic observing function of an endoscope is
used to confirm a position of the second duct before discharging
the adhesive from the first duct toward the second duct.
[0324] Item 8. The fistulectomy method according to Item 6, further
comprising:
[0325] using an endoscope to endoscopically lead the puncture
needle to the first duct.
[0326] Item 9. The fistulectomy method according to Item 8, further
comprising:
[0327] pouring a liquid into a balloon arranged at a distal end of
an insertion section of the endoscope to inflate the balloon, and
moving the first duct toward the second duct side to bond the first
duct to the second duct.
[0328] Item 10. The fistulectomy method according to Item 8,
further comprising:
[0329] generating stronger ultrasonic vibration which is different
from an ultrasonic transducer for ultrasonic observation by the
endoscope to further strongly allow parts bonded with the adhesive
to be appressed against each other by the ultrasonic vibration.
[0330] Item 11. The fistulectomy method according to Item 8,
further comprising:
[0331] endoscopically arranging an energy treatment instrument
capable of generating stronger ultrasonic vibration which is
different from an ultrasonic transducer for ultrasonic observation
by the endoscope to allow parts bonded with the adhesive to be
further strongly appressed against each other by the ultrasonic
vibration.
[0332] Item 12. A fistulectomy method of forming a fistula between
a first duct and a second duct, comprising:
[0333] sticking a puncture needle into the second duct from the
first duct;
[0334] arranging in the second duct a first balloon provided at a
distal end on an outer peripheral surface of a cylindrical member
through a puncture portion punctured with the puncture needle;
[0335] inflating the first balloon;
[0336] pushing an inner wall of the second duct toward the first
duct side in a state where the first balloon is inflated to move
the second duct toward the first duct side, and arranging in the
first duct a second balloon provided on a proximal end side of the
first balloon on the outer peripheral surface of the cylindrical
member;
[0337] inflating the second balloon to hold wall surfaces of the
first and second ducts;
[0338] holding the wall surfaces of the first and second ducts
between the first and second balloons to allow the wall surfaces to
adhere to each other in a state where the puncture portion is
maintained on the outer peripheral surface of the cylindrical
member; and
[0339] deflating the first and second balloons and pulling out the
cylindrical member from the puncture portion to form a fistula.
[0340] Item 13. The fistulectomy method according to Item 12,
further comprising:
[0341] using a forceps channel of an endoscope to endoscopically
lead the puncture needle to the first duct.
[0342] Item 14. The fistulectomy method according to Item 12,
further comprising:
[0343] using an ultrasonic observing function of an endoscope to
recognize a position of the second duct before sticking the
puncture needle from the inside of the first duct toward the second
duct.
[0344] Item 15. The fistulectomy method according to Item 12,
further comprising:
[0345] avoiding deflation by a check valve provided at a part
remaining in the first duct in a fluid duct coupled to allow
inflow/outflow of fluid with respect to each of the first and
second balloons when inflating the first and second balloons.
[0346] Item 16. The fistulectomy method according to Item 15,
further comprising:
[0347] making a cut in at least a part between the check valve in
the fluid duct and the balloons when deflating the first and second
balloons.
[0348] Item 17. A catheter with balloons which is arranged in a
fistula, comprising:
[0349] a cylindrical member having a distal end and a proximal
end;
[0350] a first balloon provided on an outer peripheral surface at
the distal end of the cylindrical member;
[0351] a second balloons provided on the outer peripheral surface
of the cylindrical member on a proximal end side of the first
balloons;
[0352] a first fluid duct which is coupled with the first balloon
and allows fluid to flow into/from the first balloon; and
[0353] a second duct which is coupled with the second balloon and
allows the fluid to flow into/from the second balloon.
[0354] Item 18. The catheter with balloons according to Item
17,
[0355] wherein the second balloon is movable toward the first
balloon in a state where the first balloon is fixed to the
cylindrical member.
[0356] Item 19. The catheter with balloons according to Item
18,
[0357] wherein the cylindrical member is provided with a first
cylindrical member in which the first balloon is arranged and a
second cylindrical member which is provided on an outer side of the
first cylindrical member and in which the second balloon is
arranged, and
[0358] engagement portions which can be engaged with each other are
provided on an outer peripheral surface of the first cylindrical
member and an inner peripheral surface of the second cylindrical
member.
[0359] Item 20. The catheter with balloons according to Item
17,
[0360] wherein a third balloon having an inflation amount smaller
than those of the first and second balloons toward the outside of
the cylindrical member in a radial direction is provided between
the first and second balloons.
[0361] Item 21. The catheter with balloons according to Item
17,
[0362] wherein check valves which allow inflation of the first and
second balloons and avoid deflation of the same are respectively
arranged in the first and second ducts on sides close to the first
and second balloons.
[0363] Item 22. A fistulectomy method of forming a fistula between
a first duct and a second duct, comprising:
[0364] arranging a first magnet in the second duct from the first
duct;
[0365] arranging a second magnet larger than the first magnet in
the first duct and holding wall surfaces of the first and second
ducts between the first and second magnets to exercise attraction
forces;
[0366] necrotizing the first and second ducts by holding based on
attraction forces of the first and second magnets to form a
fistula; and
[0367] discharging the first magnet into the first duct through the
fistula and dropping the first and second magnets in the first
duct.
[0368] Item 23. The fistulectomy method according to Item 22,
further comprising:
[0369] using an endoscope to endoscopically arrange the first
magnet in the second duct from the first duct.
[0370] Item 24. The fistulectomy method according to Item 22,
further comprising:
[0371] using an ultrasonic observing function of an endoscope to
recognize a position of the second duct before arranging the first
magnet from the inside of the first duct toward the second
duct.
[0372] Item 25. The fistulectomy method according to Item 22,
further comprising:
[0373] leading the first magnet to the second duct from the first
duct by an endoscope.
[0374] Item 26. The fistulectomy method according to Item 22,
further comprising:
[0375] using the first magnet with a cord-like member to stick a
puncture needle into the second duct from the first duct and
arranging the first magnet in the second duct.
[0376] Item 27. The fistulectomy method according to Item 26,
further comprising:
[0377] pulling the cord-like member coupled with the first magnet
when moving the second duct toward the first duct side.
[0378] Item 28. A magnet retaining device which retains a magnet
which is magnetically attached to the other magnet through a wall
surface of a biomedical tissue, comprising:
[0379] a puncture needle having a needle tube at a distal end;
[0380] a side hole provided in the needle tube;
[0381] a magnet provided to allow access from the side hole;
and
[0382] a stylet which is detachable at a proximal end of the needle
tube and discharges the magnet from the side hole by insertion.
[0383] Item 29. The magnet retaining device according to Item
28,
[0384] wherein a cord-like member is fixed to the magnet.
[0385] Item 30. A magnet assembly which is magnetically attached to
the other magnet through a wall surface of a biomedical tissue,
comprising:
[0386] a linear cord-like member;
[0387] a plurality of magnets into which the cord-like member is
inserted and which are aligned; and
[0388] a stopper which is provided to the cord-like member and
prevents the magnets from falling from the cord-like member.
[0389] Item 31. The magnet assembly according to Item 30,
[0390] wherein the cord-like member is provided with a whirl-stop
shape which can move the magnets in an axial direction and
restricts swiveling in a periaxial direction of the cord-like
member.
[0391] Item 32. The magnet assembly according to Item 30,
[0392] wherein each of the plurality of magnet is formed in such a
manner that a string on an inner peripheral side is shorter than a
string on an outer peripheral side.
[0393] Item 33. The magnet assembly according to Item 30,
[0394] wherein a spacer which prevents the magnets adjacent to each
other from being magnetically attached to each other is arranged
between the plurality of magnets.
[0395] Item 34. The magnet assembly according to item 33,
[0396] wherein the spacer can be embedded in the magnets.
[0397] Item 35. The magnet assembly according to Item 33,
[0398] wherein the spacer can be removed from a space between the
magnets.
[0399] Item 36. The magnet assembly according to Item 33,
[0400] wherein the spacer is formed of a biocompatible
material.
[0401] Item 37. A magnet assembly which is magnetically attached to
the other magnet through a wall surface of a biomedical tissue,
comprising:
[0402] an annular cord-like member;
[0403] a plurality of magnets into which the cord-like member is
inserted and which are aligned; and
[0404] a stopper which slides in a state where the cord-like member
is superimposed thereon and can increase/reduce a loop shape of the
cord-like member on a side where the magnets are arranged.
[0405] Item 38. The magnet assembly according to Item 37,
[0406] wherein the cord-like member is provided with a whirl-stop
shape which can move the magnets in an axial direction and
restricts swiveling in a periaxial direction of the cord-like
member.
[0407] Item 39. The magnet assembly according to Item 37,
[0408] wherein each of the plurality of magnets is formed in such a
manner that a string on an inner peripheral side is shorter than a
string on an outer peripheral side.
[0409] Additional advantages and modifications will readily occur
to those skilled in the art. Therefore, the invention in its
broader aspects is not limited to the specific details and
representative embodiments shown and described herein. Accordingly,
various modifications may be made without departing from the spirit
or scope of the general invention concept as defined by the
appended claims and their equivalents.
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