US20080051626A1 - Fistulectomy method between first duct and second duct, ultrasonic endoscope, catheter with balloon, magnet retaining device, and magnet set - Google Patents

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.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• 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.
• 2. Description of the Related Art
• U.S. Pat. No. 5,690,656 discloses “Method and apparatus for creating abdominal visceral anastomoses”.
• 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
• 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:
• 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.
• 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.
• 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
• 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.
• 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;
• FIG. 2 is a schematic view showing an endoscopic system according to the first embodiment of the present invention;
• 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;
• 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;
• 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;
• FIG. 6 is a schematic view showing a T-bar retaining device in the endoscopic system according to the first embodiment;
• 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;
• 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;
• 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;
• 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.
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• FIG. 19 is a schematic view showing an endoscopic system according to a second embodiment of the present invention;
• 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;
• 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;
• FIG. 22 is a schematic view showing a puncture needle for ultrasonic observation in the endoscopic system according to the second embodiment;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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 anarrow33 inFIG. 31;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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 inFIGS. 34 and 35 is modified;
• 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 inFIGS. 34 and 35 is modified;
• 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 inFIGS. 42A and 42B in the endoscopic system according to the fourth embodiment;
• 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 inFIG. 43 in the endoscopic system according to the fourth embodiment;
• 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 inFIG. 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;
• 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 inFIG. 44 in the endoscopic system according to the fourth embodiment and then the duct is cut in order to deflate the balloon;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• FIG. 52 is a schematic vertical cross-sectional view showing a catheter with balloons in an endoscopic system according to a sixth embodiment;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• FIG. 60 is a schematic view showing an endoscopic system according to an eighth embodiment of the present invention;
• FIG. 61 is a schematic partial cross-sectional view showing a magnet assembly retaining device in the endoscopic system according to the eighth embodiment;
• 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;
• 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;
• 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;
• FIG. 64A is a schematic view showing a magnet used in the magnet assembly in the endoscopic system according to the eighth embodiment;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• FIG. 72B is a schematic view showing a state in which magnets of the magnet assembly depicted inFIG. 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;
• FIG. 72C is a schematic view showing a state in which magnets of the magnet assembly depicted inFIG. 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;
• FIG. 73A is a schematic view showing a magnet used in the magnet assembly in the endoscopic system according to the eighth embodiment;
• 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;
• FIG. 73C is a schematic view showing a state in which the magnets depicted inFIG. 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 inFIG. 73B are arranged between the magnets;
• FIG. 73D is a schematic view showing a state of a magnetic force of the magnet assembly depicted inFIG. 73C used in the magnet assembly in the endoscopic system according to the eighth embodiment;
• 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;
• FIG. 74B is a schematic view showing a state of a magnetic force of the magnet assembly depicted inFIG. 74A used in the magnet assembly in the endoscopic system according to the eighth embodiment;
• 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;
• 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;
• 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;
• 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 anarrow77B inFIG. 77A;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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;
• 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
• 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
• The best mode for carrying out the present invention will be described hereinafter with reference to the accompanying drawings.
• A first embodiment will now be explained in conjunction withFIGS. 1 to 18.
• 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.
• Anendoscopic system10 shown inFIG. 2 is provided with anultrasonic endoscope12, an over-tube14 and a T-bar retaining device16. The T-bar retaining device16 is endoscopically used together with theultrasonic endoscope12.
• Theultrasonic endoscope12 includes anelongated insertion section22, anoperation section24 provided at a proximal end of theinsertion section22, and auniversal cord26 extended from theoperation section24. Theinsertion section22 is provided with a distal endhard portion32, a bendingportion34 and aflexible tube portion36. The bendingportion34 can be curved in a desired direction by swiveling a bendingoperation knob24aof theoperation section24. Theflexible tube portion36 is bent in accordance with a shape of a biomedical duct. A forceps channel38 (seeFIG. 3) is inserted into a part from theinsertion section22 to theoperation section24. A proximal end of theforceps channel38 is provided at theoperation section24. Aforceps tap38bis arranged in an opening portion (a forceps opening) of theforceps channel38 on the proximal end side.
• As shown inFIG. 3, an electronic convex typeultrasonic transducer42 for ultrasonic observation, a distalend opening portion38aof theforceps channel38 and anobject lens44 for optical observation are arranged on a distal end surface of the distal endhard portion32. Although not shown, an illumination lens from which light for optical observation exits is also arranged on the distal end surface of the distal endhard portion32.
• Therefore, theultrasonic endoscope12 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 theultrasonic transducer42, but it is, e.g., approximately 20 mm to 70 mm from a contact surface on which theultrasonic transducer42 comes into contact with a biomedical tissue.
• Theultrasonic transducer42, the distalend opening portion38aof theforceps channel38 and theobject lens44 are arranged in alignment along a direction perpendicular to an axial direction of theinsertion section22. In particular, the distalend opening portion38aof theforceps channel38 is arranged on a substantially central axis of the distal end hard portion32 (the insertion section22), and theultrasonic transducer42 and theobject lens44 are arranged at symmetrical positions with respect to the distalend opening portion38aof theforceps channel38. That is, the distalend opening portion38ais arranged at a central part between theobject lens44 and theultrasonic transducer42.
• As shown inFIG. 4, the over-tube14 is formed into a double structure. The over-tube14 is provided with anouter tube52, aninner tube54 and a coil (a coil needle)56. It is preferable for thecoil56 to have insulating properties, and it is more preferable for thecoil56 to be formed of a bioabsorbable material. Furthermore, thecoil56 may be formed of a shape-memory material. Thecoil56 is arranged at a distal end of theinner tube54. Aspiral groove54ais formed on an inner peripheral surface at the distal end of theinner tube54. Therefore, thecoil56 is detachably engaged with (screwed in) thespiral groove54aon the inner peripheral surface at the distal end of theinner tube54 by friction.
• As shown inFIG. 5, a proximal end of thiscoil56 is rounded in order to prevent a puncture from being formed in theinner tube54 when thecoil56 is engaged with thespiral groove54aof theinner tube54. On the other hand, a distal end of thecoil56 protruding with respect to the distal end of theinner tube54 is formed into a needle-like shape.
• As shown inFIG. 4, theouter tube52 is movable with respect to theinner tube54, and can cover thecoil56 at the distal end of theinner tube54 when theinsertion section22 of theendoscope12 is inserted into a body cavity.
• As shown inFIG. 6, the T-bar retaining device16 is provided with an outer sheath (a main body)62, atubular needle structure64 and anelectric scalpel structure66. Theneedle structure64 is movable in an inner cavity of theouter sheath62. Moreover, theelectric scalpel structure66 is movable in an inner cavity of theneedle structure64. Since insertion into theforceps channel38 of theendoscope12 is required, an external diameter of theouter sheath62 is slightly smaller than a bore diameter of theforceps channel38, and theouter sheath62, theneedle structure64 and theelectric scalpel structure66 are formed to be longer than a length of theforceps channel38.
• As shown inFIGS. 6 and 7, theneedle structure64 is provided with aneedle tube72, a flexible tube (an inner sheath)74 and aneedle slider76. Theneedle tube72 is fixed at a distal end of theflexible tube74, and theneedle slider76 is fixed at a proximal end of theflexible tube74.
• As shown inFIGS. 6 and 8, theelectric scalpel structure66 includes a rod-like bar (a member (an evagination member) larger than a cord-like member84)82, the cord-like member84, acore portion86 and acore slider88. Thebar82 is fixed at a distal end of the cord-like member84, and a distal end of thecore portion86 is fixed at a proximal end of the cord-like member84. In particular, the distal end of the cord-like member84 is fixed at the center of thebar82. Therefore, when the cord-like member84 is pulled, a relationship between thebar82 and the cord-like member84 becomes a substantially-T-like form. Further, a length of thebar82 is formed to be smaller than an internal diameter of thecoil56. Thecore portion86, the cord-like member84 and thebar82 have electroconductivity. Furthermore, thecore slider88 which is a connector of an electrode is fixed at a proximal end of thecore portion86. Therefore, a high-frequency current can be flowed through thecore slider88, thecore portion86, the cord-like member84 and thebar82.
• Moreover, before use of the T-bar retaining device16, as shown inFIG. 9, thebar82 and the cord-like member84 are fixed in a state where they are held in theneedle tube72. Thecore portion86 is used as a pusher for thebar82. Therefore, when thecore slider88 is moved forward, thecore portion86 moves and thebar82 is pushed out from a distal end of theneedle tube72.
• Additionally, the distal end of theneedle tube72 in theneedle structure64 can be switched between a state where it protrudes from a distal end of theouter sheath62 and a state where it is retracted into the distal end of theouter sheath62 by an operation of theneedle slider76. Further, before thebar82 is pushed out from the distal end of theneedle tube72, theelectric scalpel structure66 moves together with theneedle structure64.
• A function of theendoscopic system10 according to this embodiment will now be described.
• As shown inFIG. 2, the over-tube14 having a double structure is fit on theinsertion section22 of theultrasonic endoscope12. Furthermore, in the over-tube14, theinner tube54 is retracted into theouter tube52 in advance. At this time, theentire coil56 engaged with the distal end of theinner tube54 is pulled in toward the proximal end side apart from the distal end of theouter tube52. In this state, theinsertion section22 of theendoscope12 and the distal end of the over-tube14 are led to the intestinal duodenum D from the oral route.
• Theultrasonic transducer42 of theultrasonic endoscope12 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 theultrasonic transducer42 of theultrasonic endoscope12.
• Theneedle tube72 of the T-bar retaining device16 is pulled in toward the proximal end side apart from the distal end of theouter sheath62. Additionally, theouter sheath62 of the T-bar retaining device16 is protruded from the distal end of theinsertion section22 of theendoscope12 through theforceps tap38bof theforceps channel38 and the distalend opening portion38aof theforceps channel38 in theultrasonic endoscope12. Theneedle slider76 of the T-bar retaining device16 is operated to protrude the distal end of theneedle tube72 from theouter sheath62.
• Further, theneedle tube72 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 theneedle tube72 exists in the choledoch duct C. In this state, thecore slider88 is moved toward a front side. Then, as shown inFIG. 10, thebar82 is pushed out from the distal end of theneedle tube72 by thecore portion86 and falls in the choledoch duct C. That is, thebar82 is arranged in the choledoch duct C. In this state, theneedle slider76 is moved to pull the distal end of theneedle tube72 into theouter sheath62. Therefore, theneedle tube72 is removed from the wall surfaces of the choledoch duct C and the intestinal duodenum D.
• In this state, thecore slider88 is pulled toward an operator's hand side with respect to theouter sheath62. Therefore, thebar82 fixed at the distal end of the cord-like member84 is pulled toward the operator's hand side. Then, as shown inFIG. 11, an inner wall of the choledoch duct C is pushed toward the intestinal duodenum D side by using thebar82 so that an outer wall of the choledoch duct C is appressed against an outer wall of the intestinal duodenum D.
• Here, theouter tube52 of the over-tube14 is moved toward the proximal end side with respect to theinner tube54. Then, thecoil56 is exposed to theouter tube52. Theinner tube54 is rotated in a predetermined direction (a first direction) in a state where it covers an outer peripheral surface of theinsertion section22 of theendoscope12. Then, as shown inFIG. 12, thecoil56 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 thecoil56 reaches the inside of the choledoch duct C, theinner tube54 is rotated in a second direction which is opposite to the first direction. Then, engagement between thecoil56 and thespiral groove54aon the inner peripheral surface of theinner tube54 at the distal end is released. Therefore, as shown inFIG. 13, thecoil56 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.
• Furthermore, a high-frequency power supply (not shown) is electrically disposed to the core slider (a connector) of the T-bar retaining device16. A high-frequency current is flowed through thecore slider88, the cord-like member84 and thebar82 from the high-frequency power supply. Therefore, as shown inFIG. 14, an opening is first formed on the wall surface of the choledoch duct C which is in contact with thebar82, 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.
• Thecoil56 is gradually absorbed into a living body with time and eventually disappears if it is formed of a bioabsorbable material. For example, when thecoil56 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.
• Moreover, if thecoil56 has insulating properties, safety is assured even though thebar82 is brought into contact with thecoil56 at the time of application of a high-frequency current. Additionally, when thecoil56 is formed of a shape-memory material, the shape of thecoil56 is changed to be more compactly wound by utilizing characteristics of the shape-memory material when thecoil56 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.
• A description will be given on a technique of taking out a calculus C_Oin 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 endoscope90 and abasket forceps92 as shown inFIG. 15.
• In this case, thebasket forceps92 is inserted into a forceps channel (not shown) of theendoscope90. Moreover, abasket portion94 of thebasket forceps92 is inserted into the biliary tract B from the fistula F. The calculus C_Ois held in thebasket portion94 to be taken out from the fistula F. Additionally, the calculus C_Ois discharged to the intestinal duodenum D. Alternatively, this calculus C_Ois collected through theendoscope12 while being held in thebasket portion94.
• After removing such a calculus C_O, when the fistula F is not required, as shown inFIGS. 16 and 17, the fistula F can be endoscopically closed from the intestinal duodenum D side by using aclip96. 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, theclip96 naturally falls in the intestinal duodenum D.
• As described above, according to the present invention, the following matters can be said.
• Thecoil56 of the over-tube14 can be readily screwed into a biomedical tissue by rotating theinner tube54 in a periaxial direction in a state where thecoil56 is attached to thespiral groove54aof theinner tube54. Furthermore, thecoil56 screwed in the biomedical tissue can be readily separated from theinner tube54 by just rotating theinner tube54 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.
• Theultrasonic transducer42 for ultrasonic observation, the distalend opening portion38aof theforceps channel38 and theobject lens44 for optical observation are arranged in alignment, and theultrasonic transducer42 and theobject lens44 are arranged at the substantially symmetrical positions with respect to the distalend opening portion38aof theforceps channel38. Therefore, visual points of an ultrasonic observation image and an optical observation image can be matched with each other. Therefore, thebar82 or the cord-like member84 of the T-bar retaining device16 can be easily confirmed when comparing an ultrasonic observation image with an optical observation image.
• Moreover, since the distalend opening portion38ais arranged at a position of the central axis of the distal endhard portion32 of theinsertion section22 of theendoscope12, a puncture can be made in a part close to the center of thecoil56 of the over-tube14 by using theneedle tube72 of the T-bar retaining device16. Additionally, when forming a fistula by using thebar82 of the T-bar retaining device16, the central axis of the coil56 (the inside of the coil56) can be readily pierced.
• 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.
• 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_toccurs in the intestinal duodenum D and a food hardly passes because of this stricture S_tas shown inFIG. 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.
• 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.
• The second embodiment will now be described hereinafter with reference toFIGS. 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.
• As shown inFIG. 19, anendoscopic system10 is provided with an electronic convex typeultrasonic endoscope12 and apuncture needle116 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 aninsertion section22 of theendoscope12 into a body cavity.
• As shown inFIG. 20, like the first embodiment, theendoscope12 includes theinsertion section22 and anoperation section24. A distal endhard portion32 of theinsertion section22 of theendoscope12 used in this embodiment is provided with anultrasonic transducer122 at a distal end thereof, and aninclined surface portion124 on which a distalend opening portion38a, anobject lens44 and an illumination lens (not shown) are arranged is provided on a proximal end side of theultrasonic transducer122. Therefore, theendoscope12 is provided as a side-view type in which theobject lens44 and the illumination lens as an optical observation optical system deviate from an axial direction of theinsertion section22.
• It is to be noted that, as shown inFIGS. 20 and 21, aballoon attachment groove126 is formed between theultrasonic transducer122 and theinclined surface portion124 in the distal endhard portion32 of theinsertion section22 in theendoscope12. As shown inFIG. 21, aballoon duct132 having an opening is formed on an opposite side of theinclined surface portion124 side on which the distalend opening portion38a, theobject lens44 and the illumination lens are provided, for example. When water (a liquid) is poured into theballoon duct132, aballoon134 fixed on theballoon attachment groove126 is inflated. When a suction force is applied to theballoon duct132, water which has inflated theballoon134 can be removed, thereby deflating theballoon134.
• As shown inFIG. 22, thepuncture needle116 for ultrasonic observation is provided with asheath142, anoperation portion144 and aneedle tube146 which is formed of, e.g., stainless steel. Thesheath142 is inserted into aforceps channel38 of theendoscope12. Theoperation portion144 is arranged at a proximal end of thesheath142. A distal end of theneedle tube146 is inserted to be movable with respect a distal end of thesheath142 by theoperation portion144. Astylet148 is arranged in theneedle tube146 to be freely inserted/removed.
• Theoperation portion144 is provided with an operation sectionmain body152 provided at the proximal end of thesheath142, aslider154 formed of a resin member slidably provided with respect to the operation sectionmain body152, and astopper156 which restricts a movable range of theslider154 provided to the operation sectionmain body152.
• Theslider154 is coupled with theneedle tube146. Therefore, when theslider154 is moved with respect to the operation sectionmain body152, theneedle tube146 moves with respect to thesheath142. Asuction mouth ring154ais arranged at a proximal end of thisslider154. As shown inFIG. 23, asyringe158 or thestylet148 is detachable with respect to thissuction mouth ring154a. InFIG. 22, thestylet148 is arranged in thesuction mouth ring154aat the proximal end of theslider154. Therefore, when theslider154 moves with respect to the operation sectionmain body152, theneedle tube146 and thestylet148 move together.
• Since theneedle tube146 of thepuncture needle116 is intended for ultrasonic observation, thepuncture needle116 is inserted into theforceps channel38 of theultrasonic endoscope12. Then, an ultrasonic image of theneedle tube146 is represented on an ultrasonic observation image in which a target region is displayed. Thereafter, an operator grasps theslider154 and rapidly moves thisslider154 toward thestopper156. Then, distal ends of thestylet148 and theneedle tube146 assuredly pierce a target region.
• A function of theendoscopic system10 according to this embodiment will now be described.
• As explained in the first embodiment, the distal end of theinsertion section22 of theultrasonic endoscope12 is led to an intestinal duodenum D. Further, a position of a choledoch duct C is confirmed based on an ultrasonic image.
• As shown inFIG. 24, the distal end of thesheath142 of thepuncture needle116 is protruded from the distalend opening portion38aof theforceps channel38 to pierce a wall portion of the intestinal duodenum D which is close to the choledoch duct C. Furthermore, as shown inFIGS. 22 and 23, thestylet148 is removed from thesuction mouth ring154aat the proximal end of theslider154 of theoperation portion144 in thepuncture needle116. Thesyringe158 having an adhesive therein is attached in thesuction mouth ring154aat the proximal end of theslider154 in place of thestylet148. Moreover, as shown inFIG. 25, the adhesive A_his discharged from the distal end of theneedle tube146 while performing observation in an ultrasonic image. It is to be noted that, as the adhesive A_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_hto have quick-drying properties.
• Further, thepuncture needle116 is removed from theforceps channel38, and a bendingportion34 of theinsertion section22 in theultrasonic endoscope12 is bent as shown inFIG. 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 bendingportion34 is held for a while, e.g., several minutes to harden the adhesive.
• 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 inFIG. 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.
• Incidentally, when pushing the inner wall of the intestinal duodenum D to move toward the choledoch duct C side, using theballoon134 as shown inFIG. 28 is also preferable. In this case, a liquid such as water is poured into theballoon134 through theballoon duct132 to inflate theballoon134, thereby pushing the wall surface of the intestinal duodenum D by theballoon134. 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.
• As described above, according to this embodiment, the following matters can be said.
• 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.
• A third embodiment will now be described with reference toFIGS. 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.
• Anendoscopic system10 according to this embodiment is provided with anultrasonic endoscope12. As different from theultrasonic transducer122 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 theultrasonic endoscope12. A button (a switch) which vibrates theultrasonic transducer122 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 anoperation section24 of theendoscope12.
• As described in the second embodiment, a bendingportion34 of aninsertion section22 of theendoscope12 is used to operate and bend acurving operation knob24aof theoperation section24, and a distal endhard portion32 of theinsertion section22 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 theultrasonic transducer122 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.
• 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 theendoscope12. 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.
• It is to be noted that, as described above in the second embodiment, generating the strong ultrasonic vibration which enables the ultrasonic treatment from theultrasonic endoscope12 is also preferable in order to facilitate adhesion of both organs after an adhesive A_his 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 inFIG. 26 described in the second embodiment, a function depicted inFIG. 29 is subsequently carried out. At this time, not only the portion bonded by the adhesive A_hbut also its periphery are caused to adhere, thereby forming a large fistula without elapse of time.
• Moreover, although the strong ultrasonic vibration for the ultrasonic treatment can be generated from theultrasonic endoscope12 itself in this embodiment, it is also preferable to cause the intestinal duodenum D to adhere to the choledoch duct C through theforceps channel38 by using anenergy treatment instrument162 as shown inFIG. 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.
• It is to be noted that, as described in the second embodiment, generating the strong ultrasonic vibration through theforceps channel38 of theultrasonic endoscope12 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_his 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 inFIG. 26 described in the second embodiment, a function illustrated inFIG. 30 is carried out. At this time, when not only the portion bonded by the adhesive A_hbut also its periphery are caused to adhere by the ultrasonic treatment, a larger fistula can be formed.
• A fourth embodiment will now be described with reference toFIGS. 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.
• Anendoscopic system10 is provided with anultrasonic endoscope12 and aballoon retaining device216 depicted inFIG. 31. As described above in the second embodiment, it is also preferable to use an over-tube in order to aid insertion of aninsertion section22 of theendoscope12.
• As shown inFIG. 31, theballoon retaining device216 is provided with an outer sheath (a pusher)222, aninner sheath224, anelectroconductive needle member226, a catheter withballoons228, and anoperation section230. Theoperation section230 includes an outersheath operation section232 coupled with theouter sheath222, an innersheath operation section234 coupled with theinner sheath224, and a non-electroconductive needlemember operation section236 coupled with theneedle member226. Stopper screws238aand238bare respectively arranged between the outersheath operation section232 and the innersheath operation section234 and between the innersheath operation section234 and the needlemember operation section236 in order to avoid operations between these members. It is to be noted that aconnector236ato/from which a high-frequency power supply which flows a high-frequency current to theneedle member226 can be attached/detached is arranged in the needlemember operation section236.
• The catheter withballoons228 is detachably arranged on an outer peripheral surface of a distal end of theinner sheath224 at a position of theouter sheath222 on a distal end side. As shown inFIGS. 31 and 32, aflange portion240 protruding toward the outside in a radial direction is formed at the distal end of theinner sheath224. Theflange portion240 is provided with a plurality ofclaw portions240aand slits240bformed between theclaw portions240a. As shown inFIGS. 32,33A and33B, an impetus is given to theseclaw portions240atoward the inside in the radial direction (a direction of a central axis of the inner sheath224). Therefore, when theneedle member226 is arranged at the distal end of theinner sheath224, thecatheter228 with balloons is prevented from coming off the distal end side of theinner sheath224. On the other hand, when theneedle member226 is removed from the distal end of theinner sheath224, theclaw portions240aclose toward the inside in the radial direction. Therefore, when theouter sheath222 is moved forward with respect to theinner sheath224, thecatheter228 with balloons comes off the distal end of theinner sheath224.
• As shown inFIGS. 34 and 35, thecatheter228 with balloons includes acylindrical member242 and a pair ofballoons244aand244b. Theballoon244aon the distal end side and theballoon244bon the proximal end side are respectively connected withindividual ducts246aand246band separately inflated/deflated.Respective cocks248aand248bare detachably connected with proximal ends of theseducts246aand246b. Asyringe250 can be attached to/detached from the proximal ends of theducts246aand246b.
• A function of theendoscopic system10 according to this embodiment will now be described.
• As described above in the second embodiment, a distal end of theinsertion section22 of theultrasonic endoscope12 is inserted to reach an intestinal duodenum D. Moreover, a position of a choledoch duct C is confirmed by using an ultrasonic image.
• The needlemember operation section236 of theballoon retaining device216 is moved toward the proximal end side with respect to the innersheath operation section234 so that a protrusion amount of the distal end of theneedle member226 from the distal end of theinner sheath224 is reduced.
• Theballoon retaining device216 is protruded from the distal end of theinsertion section22 of theendoscope12 through theforceps channel38. Additionally, the needlemember operation section236 is moved toward a front side with respect to the innersheath operation section234 to protrude theneedle member226 from the distal end of theinner sheath224 of theballoon retaining device216. Further, thisneedle member226 is energized with a high-frequency current from theconnector236a. Then, a puncture is formed in wall surfaces of the intestinal duodenum D and the choledoch duct C. Furthermore, as shown inFIG. 36, theinner sheath224 and the catheter withballoons228 are led to the choledoch duct C along this puncture. At this time, in particular, after thesyringe250 is attached at the proximal end of theduct246a, thecock248ais opened to pour a gas (air) or a liquid (water or a normal saline solution) into theballoon244aon the distal end side so that theballoon244ais inflated as shown inFIG. 37. Moreover, thecock248ais closed and thesyringe250 is removed.
• Additionally, the entireballoon retaining device216 is pulled toward an operator's hand side. Therefore, the choledoch duct C is pulled toward the intestinal duodenum D side. Further, as shown inFIG. 38, theballoon244bon the proximal end side is inflated in a state where theballoon244bon the proximal end side is arranged in the intestinal duodenum D. At this time, after thesyringe250 is attached at the proximal end of theduct246b, thecock248bis opened to pour a gas or a liquid into theballoon244bon the proximal end side so that theballoon244bis inflated. Then, thecock248bis closed and thesyringe250 is removed.
• Therefore, wall portions of the choledoch duct C and the intestinal duodenum D are held between theinflated balloons244aand244bon the distal—end side and the proximal end side.
• Furthermore, as shown inFIG. 39, theneedle member226 is pulled out of theinner sheath224. Then, theclaw portions240adwindle toward the inside along the radial direction. Therefore, theclaw portions240aare removed from a position facing the distal end of thecylindrical member242. Moreover, theinner sheath224 and theneedle member226 are removed from theouter sheath222. Then, as shown inFIG. 40, the catheter withballoons228 pierces the wall surface of the intestinal duodenum D and the wall surface of the choledoch duct C, and the twoballoons244aand244bhold 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 thecylindrical member242.
• When several days pass in this state, the wall portions of the choledoch duct C and the intestinal duodenum D held between the twoballoons244aand244bare caused to adhere to each other. In a condition where an adhesion state is stabilized and a fistula is formed, theballoon244aon the distal end side is first deflated. At this time, after thesyringe250 is attached to theduct246a, thecock248ais opened to remove the gas or the liquid from theballoon244aon the distal end side, thereby deflating theballoon244a.
• Additionally, thecylindrical member242 is pulled toward the intestinal duodenum D side. Then, thecylindrical member242 is taken out to the intestinal duodenum D side, and the fistula F remains as shown inFIG. 41. Then, theballoon244bon the proximal end side is deflated like theballoon244aon the distal end side, and theendoscope12 is used to collect thecatheter228 with balloons.
• As described above, according to this embodiment, the following matters can be said.
• Theballoon244aon the distal end side and the balloon224bon the proximal end side of thecatheter228 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 thecylindrical member242.
• It is to be noted that thecocks248aand248bare detachably provided in this embodiment as described above, but the following structure can be adopted in place of thecocks248aand248b.
• As shown inFIGS. 42A and 42B, in thecatheter228 with balloons, thefirst duct246ais extended toward the proximal end side through an inner cavity of thecylindrical member242. As shown inFIG. 43,check valves252aand252bare arranged at the proximal ends of theducts246aand246bcommunicating with theballoons244aand244bon the distal end side and the proximal end side, respectively. Each of theducts246aand246bis 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.
• When pouring, e.g., a gas (air) or a liquid (a normal saline solution) into theballoon244bthrough thecheck valve252b, as shown inFIG. 44, pouring is performed with anarrow duct254 being arranged in theduct246b. Thecheck valve252bprevents air or the normal saline solution from being removed after theballoon244bis inflated, thereby maintaining the inflated state.
• In case of deflating theballoon244bin order to retain the fistula after formation of the fistula by adhesion, a hole is formed (a cut is made) in theduct246bat a position which is closer to theballoon244bthan thecheck valve252bas shown inFIG. 45A, or theduct246bincluding thecheck valve252bis cut off as shown inFIG. 45B. Then, the gas or the normal saline solution leaks from theballoons244aand244b, and theballoons244aand244bare deflated. At this time, a hole is made in thefirst duct246aor thefirst duct246ais cut off before thesecond duct246b. Furthermore, theballoon244aon the distal end side is deflated to pull out the catheter withballoons228 toward the intestinal duodenum D side. Thereafter, theballoon244bon the proximal end side is likewise deflated and collected by using theendoscope12.
• Theballoons244aand244bcan be inflated/deflated with the end portions of theducts246aand246bof the catheter withballoons228 connected with theducts246aand246bhaving thecheck valves252aand252bbeing arranged in a body.
• A fifth embodiment will now be described with reference toFIGS. 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.
• As shown inFIG. 46, aballoon retaining device216 is provided with anouter sheath222, aninner sheath224, aneedle member226, acatheter228 with balloons and anoperation section230 like the fourth embodiment. A distal end side of theinner sheath224 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 withballoons228 is detachably arranged on an outer peripheral surface of the thin-walled part of theinner sheath224 on the distal end side at a position of a distal end side of theouter sheath222.
• As shown inFIGS. 47A and 47B, thecatheter228 with balloons includes a firstcylindrical member262a, a secondcylindrical member262aand first andsecond balloons244aand244b. Thefirst balloon244ais arranged on an outer peripheral surface at a distal end of the firstcylindrical member262a. Afirst ratchet portion264ais formed on an outer peripheral surface at a proximal end of the firstcylindrical member262a.
• Thesecond balloon244bis arranged on an outer peripheral surface at a distal end of the secondcylindrical member262b. Asecond ratchet portion264bwhich can be engaged with thefirst ratchet portion264bis formed on an inner peripheral surface at the distal end of the secondcylindrical member262b. Theouter sheath222 is arranged on the proximal end side of this secondcylindrical member262b. Theouter sheath222 is relatively movable with respect to theinner sheath224. Therefore, the proximal end of the secondcylindrical member262bcan be pushed toward the distal end side. Accordingly, movement of theouter sheath222 with respect to theinner sheath224 can increase/reduce a distance between thefirst balloon244aand thesecond balloon244b. Moreover, since thefirst ratchet portion264aand thesecond ratchet portion264bare ratchet-engaged with each other, they are fixed at arbitrary positions in an axial direction.
• A function of theendoscopic system10 according to this embodiment will now be described.
• A distal end of aninsertion section22 of theultrasonic endoscope12 is inserted to reach an intestinal duodenum D. Additionally, a position of a choledoch duct C is confirmed by using an ultrasonic image.
• A needlemember operation section236 of theballoon retaining device216 is moved toward the proximal end side with respect to an innersheath operation section234 to reduce a protruding amount of the distal end of theneedle member226 from the distal end of theinner sheath224.
• Theballoon retaining device216 is protruded from the distal end of theinsertion section22 of theendoscope12 through aforceps channel38. Further, theneedle member226 is protruded from the distal end of theballoon retaining device216, and theneedle member226 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 inFIG. 48, theinner sheath224 and the catheter withballoons228 are led to the choledoch duct C along this puncture. At this time, as shown inFIG. 49, in particular, thefirst balloon244aon the distal end side is inflated by pouring a gas or a liquid through theduct246a.
• Moreover, the entireballoon retaining device216 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 inFIG. 50, theballoon244bon the proximal end side is inflated in a state where theballoon244bon 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 thefirst balloon244aon the distal end side and thesecond balloon244bon the proximal end side.
• Further, theouter sheath222 is moved forward with respect to theinner sheath224. Then, thesecond balloon244bof the secondcylindrical member262bmoves closer to thefirst balloon244aof the firstcylindrical member262awhile effecting ratchet engagement. Therefore, as shown inFIG. 51, the wall portions of the choledoch duct C and the intestinal duodenum D are held between thefirst balloon244aon the distal end side and thesecond balloon244bon the proximal end side by an approach of the inflated first andsecond balloons244aand244b.
• Subsequently, theneedle member226 is removed from theinner sheath224. Then, clawportions240adwindle toward the inside along a radial direction. Therefore, theclaw portions240aare removed from a position facing the distal end of the firstcylindrical member262a. Further, theinner sheath224 is removed from theouter sheath222. Then, the catheter withballoons228 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 twoballoons244aand244b. Therefore, bile is discharged into the intestinal duodenum D from the choledoch duct C through the firstcylindrical member262a.
• When several days pass in this state, the wall portions of the choledoch duct C and the intestinal duodenum D held between the twoballoons244aand244bare caused to adhere to each other. In a state where an adhesion condition is stabilized and a fistula is formed, theballoon244aon the distal end side is first deflated. Furthermore, the first and secondcylindrical members262aand262bare pulled toward the intestinal duodenum D side. Then, the first and secondcylindrical members262aand262bare taken out to the intestinal duodenum D side, and the fistula remains. Moreover, theballoon244bon the proximal end side is also deflated, and the catheter withballoons228 is collected through theendoscope12.
• A subsequent function is the same as that described in conjunction with the fourth embodiment. Therefore, a description on the effect will be omitted.
• As mentioned above, according to this embodiment, the following matters can be said.
• A large distance between theballoon244aon the distal end side and theballoon244bon 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 theinflated balloon244aon the distal end side and theinflated balloon244bon the proximal end side. Thereafter, theballoon244bon the proximal end side is moved closer to theballoon244aon 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.
• A sixth embodiment will now be described with reference toFIGS. 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.
• As shown inFIG. 52, athird balloon244cis arranged between afirst balloon244aon a distal end side and asecond balloon244bon a proximal end side. As depicted inFIG. 53, thisthird balloon244cis formed in such a manner that its maximum external diameter becomes smaller than a maximum external diameter of each of the first andsecond balloons244aand244b.
• Here, as described above, the first andsecond balloons244aand244bare used to hold wall surfaces of a choledoch duct C and an intestinal duodenum D therebetween. Therefore, thethird balloon244cbetween the first andsecond balloons244aand244bis used to increase a fistula. According to this structure, inflating thethird balloon244ccan increase an opening diameter of the fistula.
• A seventh embodiment will now be described with reference toFIGS. 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.
• Anendoscopic system10 is provided with an electronic convex typeultrasonic endoscope12 and apuncture needle116 for ultrasonic observation (seeFIG. 22). As shown inFIGS. 54A and 55, aside hole312 is formed in aneedle tube146 of thispuncture needle116 along its longitudinal axis direction. As shown inFIGS. 54A and 54B, a magnet (a first magnet)322 with a cord-like member324 is arranged in theneedle tube146 to be detachable from theside hole312. Thismagnet322 has a supportingpoint portion326 formed on an outer peripheral surface at a distal end thereof. This supportingpoint portion326 is brought into contact with a distal end of theside hole312 and can swivel with the distal end of theside hole312 as a supporting point. On the other hand, themagnet322 has aninclined surface portion328 at a proximal end on a side facing a proximal end of theside hole312. Thisinclined surface portion328 is formed in such a manner that themagnet322 can be readily discharged to the outside while swiveling with the supportingpoint portion326 as the supporting point when a distal end of astylet148 which can be freely inserted/removed is brought into contact with theinclined surface portion328. That is, theinclined surface portion328 is a part which exercise a force when causing themagnet322 to drop off theside hole312 with the supportingpoint portion326 serving as the supporting point.
• It is to be noted that a later-describedsecond magnet330 carried into a body cavity by theendoscope12 is formed to have an area covering the largest surface of a plurality of surfaces of thefirst magnet322.
• A function of theendoscopic system10 according to this embodiment will now be described.
• A distal end of aninsertion section22 of theultrasonic endoscope12 is inserted to reach an intestinal duodenum D. Further, a position of a choledoch duct C is confirmed by using an ultrasonic image.
• Theneedle tube146 of thepuncture needle116 for ultrasonic observation from which thestylet148 has been removed pierces the intestinal duodenum D and the choledoch duct C. Furthermore, thestylet148 is put in theneedle tube146, and theinclined surface portion328 of themagnet322 is pushed by the distal end of thestylet148. Then, as shown inFIG. 56, themagnet322 swivels to be discharged to the outside of theneedle tube146 by the supportingpoint portion326 of themagnet322. At this time, a proximal end of a cord-like member324 coupled with themagnet322 remains on the intestinal duodenum D side while maintaining a state where the cord-like member324 pierces the intestinal duodenum D and the choledoch duct C. Moreover, theneedle tube146 is pulled out of the intestinal duodenum D and the choledoch duct C, and thepuncture needle116 for ultrasonic observation is pulled out of aforceps channel38 of theendoscope12.
• Additionally, as shown inFIG. 57, a treatment instrument (a straight grasping forceps)332 grasping thesecond magnet330 at a distal end thereof is newly introduced into the intestinal duodenum D from theforceps channel38. Further, existence of the cord-like member324 coupled with thefirst magnet322 is recognized based on optical observation using theendoscope12.
• When thesecond magnet330 is arranged in the intestinal duodenum D, thefirst magnet322 and thesecond magnet330 attract each other by magnet attraction forces. Therefore, as shown inFIG. 58, outer walls of the choledoch duct C and the intestinal duodenum D are appressed against each other by functions of the first andsecond magnets322 and330. At this time, positions of themagnets322 and330 can be adjusted by operating the cord-like member324 coupled with thefirst magnet322. Furthermore, a part held between thefirst magnet322 and thesecond magnet330 undergoes ischemia due to compression by attraction forces of themagnets322 and330. When such ischemia lasts long, a tissue of this part becomes necrotic. At this time, since an area of thesecond magnet330 is larger than that of thefirst magnet322 and only a part where thefirst magnet322 is appressed against the inner wall of the choledoch duct C is compressed, a tissue of this part become necrotic.
• Moreover, a fistula F is formed in this necrotic part. At this time, since thesecond magnet330 is formed to have a larger area than that of thefirst magnet322, thefirst magnet322 passes through the fistula F, but thesecond magnet330 cannot pass through the fistula F. Therefore, as shown inFIG. 59, the first andsecond magnets322 and330 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.
• It is to be noted that the cord-like member324 is coupled with thefirst magnet322, and hence the first andsecond magnets322 and330 which has fallen off are caught in the intestinal duodenum D. Therefore, the cord-like member324 which has been inserted into theforceps channel38 of the endoscope is pulled toward the intestinal duodenum D in order to remove the cord-like member324 from the wall surfaces of the choledoch duct C and the intestinal duodenum D. Further, in this state, theendoscope12 is used to collect themagnets322 and330 or drop them in the intestinal duodenum D to be discharged.
• As described above, according to this embodiment, the following matters can be said.
• Since thefirst magnet322 is formed to be smaller than thesecond magnet330, a part which becomes necrotic due to ischemia can be restricted to a region in which thefirst magnet322 is appressed against the choledoch duct C. Therefore, thesecond magnet330 can be prevented from falling off on the choledoch duct C side.
• An eighth embodiment will now be described with reference toFIGS. 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.
• As shown inFIG. 60, anendoscopic system10 is provided with an electronic convex typeultrasonic endoscope12 and a magnetassembly retaining device416.
• As shown inFIG. 61, the magnetassembly retaining device416 includes anouter sheath422, a pusher (an inner sheath)424, anoperation section426, and awire428 having ahook428aat a distal end thereof. Theouter sheath422, thepusher424 and thewire428 have flexibility so that they are bent in accordance with bending of aninsertion section22 of theendoscope12 when they are inserted into aforceps channel38 of theendoscope12. Thepusher424 is formed of, e.g., a coil consisting of a metal material.
• Theoperation section426 is provided with an operation sectionmain body432 and a slider (a hook operation section)434 which can slide with respect to this operation sectionmain body432. Thetubular pusher424 is fixed at a distal end of the operation sectionmain body432. Theouter sheath422 is arranged on an outer periphery of thepusher424. Thewire428 is inserted into thepusher424, and a proximal end of thewire428 is fixed to theslider434.
• Amagnet assembly440 shown inFIGS. 62A and 62B is arranged on ahook428aat the distal end of thewire428. As illustrated inFIGS. 62A and 62B, themagnet assembly440 is provided with a loop-shaped cord-like member442, a plurality ofmagnets444 aligned by this cord-like member442, and astopper446 which prevents themagnets444 from falling off the cord-like member442. As shown inFIG. 62B, themagnet assembly440 forms a substantially circular shape when themagnets444 adjacent to each other move along the cord-like member442 to be magnetically attached to each other.
• Thestopper446 moves along the cord-like member442 to change a size of a loop-shaped part of the cord-like member442. Thisstopper446 is engaged with the cord-like member442 by a frictional force. It is to be noted that thestopper446 is formed of, e.g., a silicone rubber material.
• As shown inFIGS. 63A and 63B, as themagnet444, 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 member442 is inserted is formed at the center of themagnet444 shown inFIG. 63B. On the other hand, a lateral cross section of the cord-like member442 combined with themagnet444 depicted inFIG. 63B is formed into, e.g., a rectangular shape (formed into a shape other than a circular shape). Therefore, eachmagnet444 is prevented from rotating in a periaxial direction of the cord-like member442. 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 inFIG. 64A, themagnets444 can be curved in an appropriate direction in a state where coupling of themagnets444 is maintained as shown inFIG. 64B.
• Moreover, as illustrated inFIG. 65, it is preferable for eachmagnet444 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 ofmagnets444 adjacent to each other are magnetically attached to each other. In this case, when thestopper446 is moved toward the distal end side of the cord-like member442 to magnetically attach themagnets444 to each other, the circular shape is gradually formed. Therefore, themagnet assembly440 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.
• A function of the magnetassembly retaining device416 according to this embodiment will now be explained. Here, a description will be given as to a case where themagnet assembly440 shown inFIGS. 62A and 62B is used.
• First, as shown inFIG. 66A, themagnet assembly440 is previously arranged in a state where it is retracted into the distal end of theouter sheath422 of the magnetassembly retaining device416. At this time, the plurality ofmagnets444 are aligned in a straight line by the cord-like member442.
• As shown inFIG. 66B, when theouter sheath422 of the magnetassembly retaining device416 is pulled with respect to thepusher424, the distal end of the cord-like member442 and thestopper446 of themagnet assembly440 are moved to the outside. In this state, theslider434 is operated with respect to the operation sectionmain body432 depicted inFIG. 61 to pull thewire428 toward an operator's hand side. Then, the cord-like member442 is pulled in toward the operator's hand side by thehook428a. Therefore, as shown inFIG. 66C, thestopper446 relatively moves forward and the loop of the cord-like member442 on the distal end side is narrowed. In this state, theslider434 shown inFIG. 61 is operated to move thewire428 toward the distal end side. Then, thehook428aprotrudes from the distal end of thepusher424. Therefore, as shown inFIG. 66D, engagement between thehook428aand the loop-shaped cord-like member442 is released so that themagnet assembly440 is separated from the magnetassembly retaining device416.
• A function of theendoscopic system10 according to this embodiment will now be described.
• The distal end of theinsertion section22 of theultrasonic endoscope12 is inserted to reach an intestinal duodenum D. Additionally, a position of a choledoch duct C is confirmed based on an ultrasonic image.
• A puncture needle116 (seeFIG. 22) described in the second embodiment is used in theforceps channel38 of theendoscope12 to form holes H₁and H₂in the choledoch duct C from the intestinal duodenum D in advance.
• As shown inFIG. 67, the distal end of theouter sheath422 of the magnetassembly retaining device416 is led into the choledoch duct C through the holes H₁and H₂formed by using the puncture needle (not shown). Further, as described above, themagnet assembly440 is separated from the magnetassembly retaining device416. That is, as shown inFIG. 68, themagnet assembly440 is discharged into the choledoch duct C. Furthermore, the magnetassembly retaining device16 is removed from theforceps channel38.
• Thereafter, a second magnet having an external diameter larger than that formed by the magnet group having a circular shape in themagnet assembly440 is introduced into the duodenum D through the forceps channel38 (seeFIG. 57). Then, as shown inFIG. 69, themagnet assembly440 is appressed against thesecond magnet330 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.
• As described above, according to this embodiment, the following matters can be said.
• When the plurality ofmagnets444 in themagnet assembly440 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 themagnets444, 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.
• It is to be noted that, as shown inFIG. 70, themagnet assembly440 in which themagnets444 have an annular shape is used as the first magnet and the annularsecond magnet330 is utilized. Moreover, the puncture needle (seeFIG. 22) pierces the inside of both the annularsecond magnet330 and theannular magnets444 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.
• Although the description has been given as to the case where the loop-shaped cord-like member442 is used in this embodiment, but it is also preferable to use the linear cord-like member452 in order to align themagnets444 in a straight line as shown inFIG. 71. In this case, aring452awhich is caught on thehook428ais formed at the proximal end of the cord-like member452. Additionally, adistal end stopper452bhaving, e.g., a spherical shape which prevents themagnets444 from falling from the distal end of the cord-like member452 is arranged at the distal end of the cord-like member452. Further, aproximal end stopper452cwhich prevents themagnets444 from falling from the proximal end side and defines a movable range of themagnets444 in cooperation with thedistal end stopper452 is arranged between thedistal end stopper452band the ring542a. It is to be noted that using a stopper which is movable along the cord-like member452 (seeFIG. 72A) as theproximal end stopper452cis also preferable.
• Furthermore, as themagnet444 used in themagnet assembly440 shown inFIGS. 72A and 72B, one which is the same as that depicted inFIG. 65 is utilized. Therefore, when thestopper446 is moved toward the distal end side of the cord-like member452 from the state shown inFIG. 72A, themagnets444 adjacent to each other are magnetically attached to each other to form a circular shape as illustrated inFIG. 72B.
• Moreover, as shown inFIG. 72C, a part of themagnet444 which is closest to thestopper446 and into which the cord-like member444 is inserted is bent. Therefore, thestopper446 can be prevented from entering a space between the magnets444 (seeFIG. 72B). That is, when the cord-like member452 which is inserted into themagnet444 closest to thestopper446 is extended from a surface of themagnet444 on the outer peripheral side, thestopper446 can be prevented from being arranged between themagnets444. Then, a shape which is further close to the circular shape can be obtained when the plurality ofmagnets444 are magnetically attached to each other.
• It is to be noted that a magnetic force equivalent to that of a large C-shaped magnet can be obtained whenmagnets456 shown inFIG. 73A and non-magnetic bodies (spacers)458 illustrated inFIG. 73B are aligned as depicted inFIG. 73C. That is, thesmall magnets456 can be collected to increase a magnetic force. Thismagnet assembly440 is used like one shown inFIGS. 66A to 66D. Therefore, even if eachmagnet456 has a small magnetic force and a small size, it is possible to obtain themagnet assembly440 having an appropriately adjustable size and a settable magnetic force intensity.
• When rod-like magnets462 shown inFIG. 74A are magnetically attached to each other as depicted inFIG. 74B, as shown inFIG. 74C, themagnet assembly440 becomes substantially equivalent to one magnet having a magnetic force corresponding to that of the twomagnets462 depicted inFIG. 74A. Therefore, coupling thesmall magnets462 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.
• 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 themagnet assembly440 into the choledoch duct C in this embodiment, but there are several methods to realize this embodiment.
• As shown inFIG. 75, for example, theendoscope12 is operated to introduce the distal end of the magnetassembly retaining device416 into the choledoch duct C from a papilla P of the intestinal duodenum D. Then, the magnetassembly retaining device416 is operated to discharge themagnet assembly440 into the choledoch duct C. Thereafter, likewise, thesecond magnet330 is led into the intestinal duodenum D. Therefore, themagnets444 in themagnet assembly440 are magnetically attached to thesecond magnet330 in the intestinal duodenum D.
• In order to discharge themagnet assembly440 into the choledoch duct C, there is another method.
• FIG. 76 shows percutaneous transhepatic cholangial drainage (PCTD). This is a method of discharging bile from atube466 arranged in the choledoch duct C through a body wall W of an abdominal region from the outside of a body.
• The magnetassembly retaining device416 is inserted into thetube466 to discharge themagnet assembly440 into the choledoch duct C. Furthermore, theinsertion section22 of theendoscope12 is introduced into the intestinal duodenum D through a mouth, and thesecond magnet330 is magnetically attached to themagnets444 in themagnet assembly440.
• A ninth embodiment will now be described with reference toFIGS. 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.
• As shown inFIG. 77A, a magnetassembly retaining device416 is provided with asheath472, apusher474 and anoperation section476. Theoperation section476 includes an operation sectionmain body482 and aslider484 which can slide along the operation sectionmain body482.
• As shown inFIGS. 77A and 77B, thesheath472 is provided with two lumens (a double lumen)486aand486bhaving two different internal diameters. Thepusher474 is arranged in thefirst lumen486ahaving a larger internal diameter in a state where thepusher474 is coupled with theslider484 of theoperation section476. A cord-like member452 is inserted into thesecond lumen486bhaving a smaller internal diameter than that of thefirst lumen486a. Moreover, aside hole488 from which a proximal end side of the cord-like member452 is extended to the outside of the magnetassembly retaining device416 is formed at a proximal end of thesecond lumen486b.
• As shown inFIG. 78, amagnet assembly440 is arranged in the magnetassembly retaining device416.Magnets492, adistal end stopper494, arear end stopper496 andspacers498 are arranged in thefirst lumen486aof the magnetassembly retaining device416 in a state where the cord-like member452 is inserted in these members. Additionally, a distal end of thepusher474 is in contact with therear end stopper496. It is to be noted that the cord-like member452 connects thefirst lumen486awith thesecond lumen486bthrough the distal end of thesheath472. Thedistal end stopper494 is temporarily fixed to the sheath472 (thefirst lumen486a) in a state where thedistal end stopper494 is pulled in toward the proximal end side of thesheath472 apart from the distal end of the same. Therefore, as will be described later, temporary fixation of thedistal end stopper494 with respect to thesheath472 can be readily released.
• As shown inFIG. 79, a throughhole492ainto which the cord-like member452 is inserted along a direction connecting an S pole with an N pole is formed in themagnet492. Furthermore, an edge of one end (a left end inFIG. 79) of the through hole192aof themagnet492 is formed into a tapered shape. That is, one end of the throughhole492aof eachmagnet492 is formed into a counter boring shape.
• As shown inFIG. 80A, a thoughhole494ainto which the cord-like member452 can be inserted is formed in thedistal end stopper494 arranged on the distal end side of the plurality ofmagnets492. A wedge-like member494bshown inFIG. 80B is arranged at one end (a left end inFIG. 80A) of the throughhole494a, and this member bites into one end of the throughhole494awhen a large force is applied thereto. Therefore, thedistal end stopper494 and the wedge-like member494bare formed of such materials as the wedge-like member494bbites into thedistal end stopper494. It is to be noted that thedistal end stopper494 is formed into a shape with which thedistal end stopper494 can be inserted into thefirst lumen486abut cannot be inserted into thesecond lumen486bin order to avoid entering thesecond lumen486bfrom the distal end side of thesheath472.
• As shown inFIG. 81A, a throughhole496ainto which the cord-like member452 can be inserted is formed in theproximal end stopper496 arranged on the proximal end side of the plurality ofmagnets492. A wedge-like member496bshown inFIG. 81B is arranged at one end (a right end inFIG. 81A) of this throughhole496a, and this member bites into the one end of the throughhole496awhen a large force is applied thereto. Therefore, theproximal end stopper496 and the wedge-like member496bare formed of such materials as the wedge-like member496bbites into theproximal end stopper496. It is to be noted that theproximal end stopper496 fixes the cord-like member452 inserted into the throughhole496a.
• As shown inFIG. 78, eachspacer498 shown inFIG. 82 is arranged between themagnets492 adjacent to each other. A throughhole498ainto which the cord-like member452 can be inserted is formed in thespacer498. Thespacer498 is formed of a flexible silicone resin material. When eachspacer498 is strongly pushed into a space between themagnets492, it enters the tapered (counter-boring-like) edge of themagnet492 shown inFIG. 79.
• A function of theendoscopic system10 according to this embodiment will now be described.
• As shown inFIG. 83A, the distal end of thesheath472 of the magnetassembly retaining device416 is arranged in the choledoch duct C. Moreover, thepusher474 is pushed in toward the distal end side of thesheath472. Then, temporary fixation between thedistal end stopper494 an thesheath472 is released and thedistal end stopper494 protrudes with respect to the distal end of thesheath472.
• As shown inFIG. 83B, the cord-like member452 on thesecond lumen486bside is strongly pulled toward an operator's hand side. Then, thedistal end stopper494 does not enter thesecond lumen486bfrom the distal end side of thesheath472, but is temporarily fixed at the distal end of thesheath472. Therefore, as shown inFIG. 83C, a distance between theproximal end stopper496 and thedistal end stopper494 is reduced. That is, eachspacer498 enters the tapered edge of the throughhole492aof eachmagnet492, and themagnets492 adjacent to each other are magnetically attached to each other as shown inFIG. 83D. At this time, as described above, themagnets492 become equivalent to a large magnet having the S pole and the N pole (seeFIG. 83E). Additionally, when the cord-like member452 is pulled to apply a pressure, the wedge-like members494band496bof thedistal end stopper494 and therear end stopper496 bite into thedistal end stopper494 and therear end stopper496, respectively. Therefore, a distance of the cord-like member452 between thedistal end stopper494 and therear end stopper496 is fixed.
• As shown inFIG. 83F, thepusher474 is pushed in toward the distal end side of thesheath472 to move theintegrated magnets492 to the outside from the distal end of thesheath472.
• As shown inFIG. 83G, thepusher474 and thesheath472 are removed to the operator's hand side. Therefore, the magnets fixed to the cord-like member452 are retained in the choledoch duct C. It is to be noted that, when a length of the cord-like member452 is too long, this member can be, e.g., cut to adjust its length.
• 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, themagnets492 fall in the intestinal duodenum D together with the cord-like member452. As described above, according to this embodiment, the following matters can be said.
• Since thespacers498 prevent themagnets492 from being magnetically attached to each other when inserting the magnetassembly retaining device416 into theforceps channel38 of the endoscope21, the magnetassembly retaining device416 can be readily inserted along a shape of a body cavity.
• Furthermore, when themagnets492 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.
• Therefore, at the time of insertion into theforceps channel38 of theendoscope12, since therespective magnets492 are separated from each other through thespacer498, 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.
• A 10th embodiment will now be described with reference toFIGS. 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.
• A magnetassembly retaining device416 shown inFIG. 84 is formed with one lumen (a single lumen) as different from thesheath472 described in the ninth embodiment.
• As shown inFIGS. 85A to 85C, in amagnet assembly440,spacers498 which readily fall off a cord-like member452 and are formed of a biocompatible material are arranged betweenmagnets492. Therefore, as themagnets492 protrude from a distal end of asheath472, thespacers498 fall off and themagnets492 adjacent to each other are magnetically attached to each other.
• It is to be noted that, in this embodiment, adistal end stopper494 and the cord-like member452 are fixed to each other as different from the ninth embodiment, but aproximal end stopper496 is movable with respect to the cord-like member452.
• A function of anendoscopic system10 according to this embodiment will now be described.
• As shown inFIG. 85A, a distal end of thesheath472 of the magnetassembly retaining device416 is arranged in a choledoch duct C through an intestinal duodenum D.
• As shown inFIG. 85B, apusher474 is moved to the distal end side of thesheath472. Adistal end stopper494 andmagnets492 protrude from the distal end of thesheath472. Then, thespacer498 falls from a space between themagnets492. Therefore, as shown inFIG. 85C, themagnets492 adjacent to each other are magnetically attached to each other.
• Further, themagnets492 adjacent to each other are sequentially magnetically attached to each other with fall of eachspacer498. Furthermore, thepusher474 is moved forward to engage and fix a wedge-like member of theproximal end stopper496 with respect to the cord-like member452. Therefore, as shown inFIG. 85D, the plurality ofmagnets492 are magnetically attached to each other to become equivalent to one magnet having a large magnetic force.
• Moreover, as shown inFIG. 85E, in a state where themagnets492 are arranged in the choledoch duct C, thesheath472 and thepusher474 are removed. The fallenspacers498 are formed of a bioabsorbable material and eventually absorbed into a body, and hence they do not remain in the choledoch duct C.
• As described above, according to this embodiment, the following matters can be said.
• Since thesheath472 with the single lumen is used in the magnetassembly retaining device416, a diameter of thesheath472 in the magnetassembly retaining device416 can be reduced to be smaller than that of the sheath with the double lumen.
• 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 eachspacer498 can be directly discharged into the jejunum J, it does not have to be formed of a bioabsorbable material.
• An 11th embodiment will now be described with reference toFIGS. 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.
• As shown inFIG. 86, first and second cord-like members454aand454bare arranged in asheath472 of a magnetassembly retaining device416.
• As shown inFIGS. 87A and 87B, the first cord-like member454ais inserted intomagnets492, adistal end stopper494, arear end stopper496 and apusher474. A plurality ofspacers498 are fixed at a distal end of the second cord-like member454bat predetermined intervals. Therefore, a proximal end of the second cord-like member454bcan be grasped on an operator's hand side to readily collect the fallenspacers498.
• According to the above description, the following items can be obtained.
• Item 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 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 a fistula on an inner side of the coil needle.
• Item 2. The fistulectomy method according to Item 1, further comprising:
• 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.
• Item 3. The fistulectomy method according to Item 2, further comprising:
• rotating the over-tube in a periaxial direction thereof when releasing engagement between the over-tube and the coil needle.
• Item 4. 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 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.
• 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
• 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.
• Item 6. A fistulectomy method of forming a fistula between a first duct and a second duct, comprising:
• sticking a puncture needle from the inside of the first duct toward the outside of the second duct;
• discharging an adhesive from the puncture needle to a space between the first duct and the second duct;
• 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
• forming a fistula on an inner side of an edge of a part where the outer wall surfaces are attached to each other.
• Item 7. The fistulectomy method according to Item 6, further comprising:
• 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.
• Item 8. The fistulectomy method according to Item 6, further comprising:
• using an endoscope to endoscopically lead the puncture needle to the first duct.
• Item 9. The fistulectomy method according to Item 8, further comprising:
• 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.
• Item 10. The fistulectomy method according to Item 8, further comprising:
• 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.
• Item 11. The fistulectomy method according to Item 8, further comprising:
• 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.
• Item 12. 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 on an outer peripheral surface of a cylindrical member through a puncture portion punctured with the puncture needle;
• inflating the first balloon;
• 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;
• inflating the second balloon to hold 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 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
• deflating the first and second balloons and pulling out the cylindrical member from the puncture portion to form a fistula.
• Item 13. The fistulectomy method according toItem 12, further comprising:
• using a forceps channel of an endoscope to endoscopically lead the puncture needle to the first duct.
• Item 14. The fistulectomy method according toItem 12, 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.
• Item 15. The fistulectomy method according toItem 12, further comprising:
• 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.
• Item 16. The fistulectomy method according to Item 15, further comprising:
• 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.
• Item 17. 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 balloons provided on the outer peripheral surface of the cylindrical member on a proximal end side of the first balloons;
• a first fluid duct which is coupled with the first balloon and allows fluid to flow into/from the first balloon; and
• a second duct which is coupled with the second balloon and allows the fluid to flow into/from the second balloon.
• Item 18. The catheter with balloons according to Item 17,
• wherein the second balloon is movable toward the first balloon in a state where the first balloon is fixed to the cylindrical member.
• Item 19. The catheter with balloons according to Item 18,
• 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
• 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.
• Item 20. The catheter with balloons according to Item 17,
• 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.
• Item 21. The catheter with balloons according to Item 17,
• 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.
• Item 22. 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 exercise attraction forces;
• necrotizing the first and second ducts by holding based on attraction forces of the first and second magnets to form a fistula; and
• discharging the first magnet into the first duct through the fistula and dropping the first and second magnets in the first duct.
• Item 23. The fistulectomy method according toItem 22, further comprising:
• using an endoscope to endoscopically arrange the first magnet in the second duct from the first duct.
• Item 24. The fistulectomy method according toItem 22, further comprising:
• 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.
• Item 25. The fistulectomy method according toItem 22, further comprising:
• leading the first magnet to the second duct from the first duct by an endoscope.
• Item 26. The fistulectomy method according toItem 22, further comprising:
• 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.
• Item 27. The fistulectomy method according toItem 26, further comprising:
• pulling the cord-like member coupled with the first magnet when moving the second duct toward the first duct side.
• 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:
• 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.
• Item 29. The magnet retaining device according to Item 28,
• wherein a cord-like member is fixed to the magnet.
• Item 30. 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 magnets from falling from the cord-like member.
• Item 31. The magnet assembly according to Item 30,
• 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.
• Item 32. The magnet assembly according to Item 30,
• 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.
• Item 33. The magnet assembly according to Item 30,
• 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.
• Item 34. The magnet assembly according toitem 33,
• wherein the spacer can be embedded in the magnets.
• Item 35. The magnet assembly according toItem 33,
• wherein the spacer can be removed from a space between the magnets.
• Item 36. The magnet assembly according toItem 33,
• wherein the spacer is formed of a biocompatible material.
• Item 37. 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 can increase/reduce a loop shape of the cord-like member on a side where the magnets are arranged.
• Item 38. The magnet assembly according to Item 37,
• 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.
• Item 39. The magnet assembly according to Item 37,
• 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.
• 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.

Claims (20)

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 toclaim 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 toclaim 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 toclaim 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 toclaim 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 toclaim 7, comprising:

using an endoscope to endoscopically lead the puncture needle to the first duct.

9. The fistulectomy method according toclaim 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 toclaim 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 toclaim 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 toclaim 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 toclaim 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.

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