WO2013035192A1

WO2013035192A1 - Method and device for treating symptom of rhinitis surgically

Info

Publication number: WO2013035192A1
Application number: PCT/JP2011/070585
Authority: WO
Inventors: 徹黄川田
Original assignee: 医療法人社団アドベント
Priority date: 2011-09-09
Filing date: 2011-09-09
Publication date: 2013-03-14

Abstract

[Problem] To make the field of vision for a part to be observed clear, and to enable the operation of a treatment to progress smoothly without causing the accumulation of a mucosal fluid or a washing fluid in a nasal cavity. [Solution] A method for treating a symptom of rhinitis surgically, comprising: a step of inserting a tip part of an endoscope (10) and a tip part of a tubular fluid path constituent member (30) that is so arranged on an insertion part (12) as to surround the outer peripheral surface of the insertion part (12) into a nasal cavity; a step of partitioning a space formed between the fluid path constituent member (30) and the outer surface of the insertion part (12) into a fluid supply gap and a fluid discharge gap, supplying a washing fluid to the fluid supply gap from the outside of the nasal cavity, introducing the washing fluid into the inside of the nasal cavity, and discharging the washing fluid in the nasal cavity into the outside of the nasal cavity through the fluid discharge gap together with a dirty fluid in the nasal cavity; a step of inserting a surgical probe into the nasal cavity; a step of exposing a posterior nasal nerve from a surrounding tissue by means of the supply and discharge of the washing fluid under the observation on the endoscope (10); and a step of severing the exposed posterior nasal nerve with the surgical probe while separating the posterior nasal nerve from the surrounding tissue.

Description

Method and apparatus for surgical treatment of rhinitis symptoms

The present invention relates to a method and apparatus for surgically treating rhinitis symptoms such as nasal congestion, and more particularly, swollen mucosa without disrupting the normal structure of the nose and retaining its structure and function. It is intended to improve the symptoms of rhinitis.

Sinusitis is a medical treatment of rhinitis, but there is little effect in such conservative treatment (drug and desensitization treatment), and if left untreated, it becomes chronic and the quality of daily life (QOL) is increased. And various problems are secondary.

Thus, surgical methods are used when conservative treatment is not effective.
For example, surgical treatment for chronic sinusitis (pyremic syndrome) includes the insertion of a rigid endoscope into the nostril and the removal of pus, excision of the inflamed mucosa, and enlargement of the excretory mouth under the observation of the rigid endoscope Or, intranasal surgery is being performed to establish a new facility.

Specifically, for example, an operator inserts the distal end portion into a nostril while holding the rigid endoscope with the left hand, and performs an operation on the surgical site while holding a surgical instrument such as a forceps or a laser probe with the right hand.

An observation system using a rigid endoscope irradiates light from a light source in the vicinity of a surgical site through a light guide, and this irradiation region is provided in the insertion portion through an objective lens provided at the distal end of the insertion portion of the rigid endoscope. The light received by the optical fiber and the light transmitted to the optical fiber is observed with a finder provided at the base of the rigid endoscope, or the light incident on the optical fiber is image-processed without looking through the finder, and an appropriate CRT display device is obtained. The displayed image is observed.

However, taking nasal cavity, especially intranasal surgery as an example, there is mucus, blood, or pus (hereinafter also referred to as mucus) in the nasal cavity, which exists as a contaminant around the rigid endoscope, Mucus obstructs the field of view of the rigid endoscope. When this visual field is obstructed, there is a risk that a part other than the target surgical part is accidentally damaged by a surgical probe such as forceps.

Therefore, it is necessary to continue the operation after removing the mucus and cleaning the visual field. For this purpose, it is necessary to pull out the rigid endoscope every time the visual field of the rigid endoscope is obstructed, and insert the tip of the suction tube into the nasal cavity, and eliminate mucus through the suction tube.

However, performing such an operation each time is a problem in performing a quick operation. Moreover, repeated insertion / extraction of the suction tube and insertion / extraction of the rigid endoscope have a great risk of damaging the intranasal tissue. Furthermore, it is necessary to wipe off the objective lens every time it becomes dirty.

Patent Document 1 discloses an endoscope apparatus in which a liquid or a gas is ejected from an objective observation front surface of an optical visual tube to remove dirt and fogging on the objective observation front surface.

In Patent Document 2, an endoscope and an electric handpiece piece that drives an ablation assembly for removing tissue are configured separately, and a cleaning liquid is sprayed from the ablation assembly to the front of the endoscope for cleaning. A cleaning system has been proposed.

However, even if a washing fluid is flowed to the front of the endoscope to secure a visual field, mucus is not excluded from the nasal cavity. Therefore, in order to secure a stable visual field, the mucus should be Kinds need to be extracted from the nasal cavity. Further, since the cleaning fluid is excessively accumulated in the nasal cavity when the cleaning is repeated, the cleaning fluid needs to be interrupted and discharged outside the nasal cavity at an appropriate time.

On the other hand, US Pat. No. 4,517,962 (Patent Document 3) shows that the liquid is supplied and the liquid in the nasal cavity is discharged. In this example, since the liquid supply and liquid discharge paths are the same, mucus and blood mixed in the waste liquid remain in the discharge path, and then when the cleaning liquid is supplied, There is a possibility that blood mixes with the cleaning liquid, contaminates the target observation site, and obscure the field of view.

Furthermore, after the operation, it is necessary to disinfect the entire endoscope, and it is necessary to carefully disinfect the narrow cleaning fluid and drainage routes. If this disinfection is inadequate, the risk of viral infection remains.

Furthermore, even in the technique of Patent Document 3, since the members constituting the fluid flow path are not disposable, it is necessary to carefully disinfect the endoscope for each patient. In addition, the risk of viral infection remains. Further, the cleaning effect of the objective lens is poor, and it is difficult to clearly see the target observation site.

Also, in the technique of Patent Document 3, since the supply and discharge paths of the cleaning liquid are the same, mucus and blood mixed in the waste liquid remain in the cleaning and discharge path. There is a problem that the mucous fluid or blood mixed into the cleaning liquid may contaminate the target observation site and obscure the field of view.

No. 5-11841 JP 2005-532869 A U.S. Pat. No. 4,517,962

However, in the prior art that only discharges the irrigation fluid, it is necessary to discharge mucus and the irrigation fluid to the outside of the nasal cavity, which interrupts the operation and is inefficient. Further, when the supply and discharge paths of the cleaning liquid are the same, there is a problem that the target observation site is contaminated and the field of view tends to be unclear.

Therefore, the main object of the present invention is to surgically treat the symptoms of rhinitis, which can clarify the field of view of the target observation site and there is no stagnation of mucus or washing fluid in the nasal cavity and the procedure can proceed smoothly. It is to provide a method for doing this.
Another objective is to clearly identify the presence of the posterior nasal nerve with an endoscope inserted through the nasal cavity, while cutting off only the posterior nasal nerve with a surgical probe while distinguishing it from the butterfly palatal artery, leaving the butterfly palatal artery remaining. It is to provide a highly effective method for surgically treating rhinitis symptoms, improving the swollen mucosa.
Another purpose is to clearly see the posterior nasal nerve (parasynthetic nerve) with an endoscope inserted through the nasal cavity, and to use a thin posterior nasal nerve (collateral exchange nerve) of only about 0.5 mm. It is to provide a system for surgical treatment of rhinitis symptoms that can be exposed from surrounding tissues.

The present invention that has solved the above problems is as follows.

<Invention of Claim 1>
A body part located outside the nasal cavity, an insertion part whose distal end side is inserted into the nasal cavity, an illumination means provided in the distal part of the insertion part, and the nasal cavity directly facing the nasal cavity and allowing light to pass therethrough A distal end portion of an endoscope having a translucent member and an optical transmission path for providing optical information in the nasal cavity passing through the translucent member to the outside, and a state surrounding an outer peripheral surface of the insertion portion Inserting a distal end portion with a tubular fluid path component provided on the nasal cavity;
A space between the fluid path constituent member and the outer surface of the insertion portion is partitioned into a fluid supply gap and a fluid discharge gap, and a cleaning fluid is supplied to the fluid supply gap from outside the nasal cavity, and the cleaning fluid is supplied to the nasal cavity. Directing into the nasal cavity and draining the nasal irrigation fluid out of the nasal cavity through the fluid drainage gap with the nasal turbid fluid;
Inserting a surgical probe into the nasal cavity;
Exposing the posterior nasal nerve from surrounding tissue under observation with the endoscope and by supplying and draining lavage fluid;
Cutting with the surgical probe while exposing the nasal nerve from the surrounding tissue after exposure;
A method for surgically treating rhinitis symptoms characterized by comprising:

(Function and effect)
In allergic rhinitis, in which conservative treatment is the first choice, there are many intractable cases that are difficult to control, particularly among the cases of perennial rhinitis. For conservative treatment resistance cases, conventionally, surgery using a laser, an argon plasma coagulation device, or trichloracetic acid has been generally performed to denature the lower turbinate mucosa, which is the “place” for allergic reactions. It was.
However, in the experience of the present inventor, there are many cases in which the effect disappears in a short time in the treatment for the lower turbinates. For such intractable allergic rhinitis and refractory sinusitis, it is considered that cutting the parasympathetic nerve is a more effective treatment.
Conventionally, surgery targeting the parasympathetic nerve is known as pterygoid nerve (Vidian nerve) cutting. There have been many reports since Golding ⁾ reported as surgical treatment for allergic rhinitis or vasomotor rhinitis. However, this operation that cuts the parasympathetic nerve in the pterygoid tube also cuts tear-secreting nerve fibers at the same time. Therefore, it has side effects such as postoperative tear secretion disorder.
On the other hand, the posterior nasal nerve, which is a peripheral branch of the pterygoid nerve (Vidian nerve), can be regarded as an important target that can be expected to have the same effect as the pterygoid nerve (Vidian nerve) amputation. Anatomically, the posterior nasal nerve is a nerve branch that enters the nasal cavity via the butterfly palate after dividing the secretory nerve to the lacrimal gland, and not only parasympathetic secretory fibers from the pterygoid nerve (Vidian nerve) Sensory nerve fibers from the second branch of the trigeminal nerve. Therefore, cutting of the posterior nasal nerve not only has the same effect as cutting of the pterygoid nerve (Vidian nerve), but also simultaneously blocks sensory nerve fibers that are centripetals of stimulation from mucous membranes with increased hypersensitivity. Therefore, theoretically, a better effect can be expected. The greatest advantage is that the secretory nerve fibers to the lacrimal gland are preserved, so that they do not cause the tear secretion disorder seen in the pterygotomy (Vidian nerve) cutting.
The present inventor tried a method of coagulating the posterior nasal nerve by irradiating a laser spot on the mucosa after confirming the butterfly palate using ultrasound for refractory perennial allergic rhinitis It was. Through this treatment, we were able to confirm that surgery for the posterior nasal nerve was extremely effective, but at the same time, we found that the method of damaging the mucous membrane has a high risk of causing posterior bleeding from the butterfly palate artery .
Based on this experience, the optimal surgery is to seek a treatment method that targets only the posterior nasal nerve without causing damage to the mucous membrane, expose the posterior nasal nerve under the periosteum at the butterfly palate, and cut it. I found out. This surgery is effective not only for watery nasal discharge and sneezing but also for nasal congestion.
In this case, it is more effective to use an operation in which a part of the inferior turbinate bone under the inferior turbinate mucosa is excised.
In any case, when the posterior nasal nerve is cut under observation with an endoscope, it is important to expose the posterior nasal nerve from surrounding tissues.
As long as the conventional device is used, the field of view of the target observation site is not clear, and the visual recognition of the posterior nasal nerve and the posterior nasal nerve cannot be exposed from the surrounding tissue.
However, in the present invention, the space between the fluid path constituent member and the outer surface of the insertion portion of the endoscope is divided into a fluid supply gap and a fluid discharge gap, and the cleaning fluid is supplied from outside the nasal cavity to the fluid supply gap. Since the cleaning fluid is guided into the nasal cavity and the cleaning fluid in the nasal cavity is discharged out of the nasal cavity through the fluid discharge gap together with the contaminant in the nasal cavity, the posterior nasal nerve is clearly visible and the posterior nasal nerve is Therefore, it becomes easy to cut only the nasal nerve with the surgical probe after the exposure. In particular, it is possible to surgically treat rhinitis symptoms that are extremely effective, in which only the posterior nasal nerve is cut with a surgical probe while distinguishing it from the butterfly palatal artery, leaving the butterfly palatal artery and improving the swollen mucosa it can.
To explain with a specific example, a surgical probe is appropriately inserted while inserting a suction / cleaning device combining an endoscope and a fluid path constituent member into the nasal cavity and bringing the tip of the endoscope close to the target tissue by about 1 to 3 mm. When the surgical operation by is advanced, fine nerves and blood vessels appearing in the progressing process can be exposed.
In this state, when washing water (saline) is injected, a water bulb is formed between the operation site (target tissue site) and the endoscope tip, and an environment in which surgery is performed in water can be formed. . In the first place, in blood, thin blood vessels and nerves are in close contact with tissues due to gravity and moisture adhering to the surfaces of blood vessels and nerves, and are difficult to identify. On the other hand, by forming an underwater environment by supplying wash water (saline), it is possible to separate thin blood vessels and nerves from tissues and easily identify them, and to lift only thin nerves. Cutting of thin nerves becomes possible.

<Invention of Claim 2>
The method for surgically treating rhinitis symptoms according to claim 1, further comprising the step of discarding the fluid path component when surgery is completed.

(Function and effect)
If the fluid path constituent member is, for example, a thin plastic tube and is discarded every time surgery is completed, it is excellent in disposable hygiene management.

<Invention of Claim 3>
A body part located outside the nasal cavity, an insertion part whose distal end side is inserted into the nasal cavity, an illumination means provided in the distal part of the insertion part, and the nasal cavity directly facing the nasal cavity and allowing light to pass therethrough In a state of surrounding the outer peripheral surface of the insertion portion of the endoscope having a translucent member and an optical transmission path for providing optical information in the nasal cavity passing through the translucent member to the outside, Removably assembling the fluid path component;
Inserting the endoscope and the tip of the fluid path component into the nasal cavity;
A space between the fluid path constituent member and the outer surface of the insertion portion is partitioned into a fluid supply gap and a fluid discharge gap, and a cleaning fluid is supplied to the fluid supply gap from outside the nasal cavity, and the cleaning fluid is supplied to the nasal cavity. Directing into the nasal cavity and draining the nasal irrigation fluid out of the nasal cavity through the fluid drainage gap with the nasal turbid fluid;
Inserting a surgical probe into the nasal cavity;
Exposing the posterior nasal nerve from surrounding tissue under observation with the endoscope and by supplying and draining lavage fluid;
Cutting with the surgical probe while exposing the nasal nerve from the surrounding tissue after exposure;
A method for surgically treating rhinitis symptoms characterized by comprising:

(Function and effect)
By making the insertion portion of the endoscope detachable with respect to the fluid path constituent member, the fluid path constituent member can be made disposable. Disposable is extremely effective in preventing patient viral infections.

<Invention of Claim 4>
A first assembly step of detachably assembling a tubular fluid path constituent member in the through hole of the cleaning fluid access holder;
A body part located outside the nasal cavity, an insertion part whose distal end side is inserted into the nasal cavity, an illumination means provided in the distal part of the insertion part, and the nasal cavity directly facing the nasal cavity and allowing light to pass therethrough The insertion portion of the endoscope having a translucent member and an optical transmission path that provides optical information in the nasal cavity passing through the translucent member to the outside is inserted into the fluid path constituent member and assembled. 2 assembly steps;
Inserting the endoscope and the tip of the fluid path component into the nasal cavity;
A space between the fluid path constituent member and the outer surface of the insertion portion is partitioned into a fluid supply gap and a fluid discharge gap, and a cleaning fluid is supplied to the fluid supply gap from outside the nasal cavity, and the cleaning fluid is supplied to the nasal cavity. Directing into the nasal cavity and draining the nasal irrigation fluid out of the nasal cavity through the fluid drainage gap with the nasal turbid fluid;
Inserting a surgical probe into the nasal cavity;
Exposing the posterior nasal nerve from surrounding tissue under observation with the endoscope and by supplying and draining lavage fluid;
Cutting with the surgical probe while exposing the nasal nerve from the surrounding tissue after exposure;
A method for surgically treating rhinitis symptoms characterized by comprising:

(Function and effect)
A cleaning fluid inlet / outlet holder is provided, and a flow path for supplying and discharging the cleaning fluid can be formed through the holder, and the operator can hold the holder to stabilize the fluid path component and the endoscope. The observation site can be observed stably.

<Invention of Claim 5>
5. The endoscope and the fluid path constituent member are integrally combined with a cleaning fluid entrance / exit holder, and the operator has a step of supplying, discharging and stopping the cleaning fluid while holding the holder. For surgical treatment of symptoms of rhinitis in children.

(Function and effect)
In the observation device, a holder that is held by the operator while holding the observation device main body and the fluid path constituent member is provided, and in this holder, a hand switch for operating the operator is provided. When it is necessary to clarify the condition, the operator can operate the hand switch with the left hand while holding a surgical probe such as forceps with the right hand, and the mucus can be eliminated. Therefore, the operator can perform a smooth operation without losing concentration.

<Invention of Claim 6>
A tubular fluid path component;
A body part located outside the nasal cavity, an insertion part inserted into the nasal cavity, an illumination means provided in the distal part of the insertion part, and a translucent light passing directly through the nasal cavity An endoscope having a member and an optical transmission path for providing optical information in the nasal cavity passing through the translucent member to the outside, and wherein the insertion portion is detachably inserted into the fluid path constituent member; A fluid supply gap and a fluid discharge gap are defined between the fluid path component and the outer surface of the insertion portion, and the fluid supply gap and the fluid discharge gap are respectively located outside and inside the nasal cavity. Communication,
Fluid supply means is connected to the fluid supply gap to supply cleaning fluid from outside the nasal cavity and guide the cleaning fluid into the nasal cavity,
Fluid discharge means is connected to the fluid discharge gap to discharge the cleaning fluid in the nasal cavity together with the contaminant in the nasal cavity to the outside of the nasal cavity,
The outlet of the cleaning fluid in the fluid supply gap opens in the vicinity of the translucent member,
A device for surgically treating rhinitis symptoms characterized by the above.
(Function and effect)
The apparatus is suitably applied to carry out the method.

<Invention of Claim 7>
Furthermore, it has a fluid inlet / outlet holder, and the fluid path constituting member is relatively detachably provided in the through hole of the holder,
A gap between the through hole of the holder and the outer surface of the fluid path constituent member is partitioned in a liquid-tight manner in the longitudinal direction to form a fluid supply path and a fluid discharge path,
In a state where the fluid path constituent member is inserted into the through hole of the holder, the supply port and the exhaust port have walls in positions corresponding to the fluid supply path and the fluid discharge path in the longitudinal direction. 7. The method for surgically treating a symptom of rhinitis according to claim 6, wherein the fluid supply path and the fluid discharge path are communicated with the fluid supply gap and the fluid discharge gap, respectively. apparatus.

<Invention of Claim 8>
The rhinitis symptom according to claim 7, wherein the holder is provided with a hand switch for operating an operator for stopping fluid supply into the fluid supply gap through the fluid supply path from the fluid supply means. A device for surgically treating.

(Function and effect)
<Invention of Claim 9>
8. The apparatus for surgically treating rhinitis symptoms according to claim 7, wherein the fluid path component is separated from the holder and the observation apparatus body and can be discarded.

According to the present invention, the field of view of the target observation site can be clarified, and mucus and washing fluid can be retained in the nasal cavity, so that the treatment can proceed smoothly.
In addition, the endoscope inserted through the nasal cavity clearly distinguishes the posterior nasal nerve from the posterior nasal nerve, while clearly observing the presence of the posterior nasal nerve. Can effectively treat the symptoms of very effective rhinitis, improving the mucous membrane.
In addition, the endoscope inserted through the nasal cavity allows the posterior nasal nerve (collateral exchange nerve) to be clearly seen and the thin posterior nasal nerve (collateral exchange nerve) of only about 0.5 mm is exposed from the surrounding tissue. The symptoms of rhinitis that can be made can be effectively treated surgically.

It is explanatory drawing which shows the position of a posterior nasal nerve. It is a schematic diagram of the apparatus configuration of the present invention. FIG. 3 is a cross-sectional view of FIG. 2. It is a fragmentary perspective view of an apparatus. It is a disassembled perspective view of an apparatus. FIG. 3 is a schematic diagram of a supply state of a cleaning liquid. It is the longitudinal cross-sectional view. It is a longitudinal cross-sectional view of the principal part. It is a longitudinal cross-sectional view of an inner cylinder packing. It is a front view of an endoscope front-end | tip part. It is an outline vertical section for explanation of a flow of cleaning fluid. It is a cross-sectional view of another example.

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.
The observation device in the nasal cavity of the present invention includes an optical observation means constituted by the observation device main body, and a supply of cleaning liquid and a discharge system for mucus in the nasal cavity.

FIG. 1 is an explanatory view of a nasal cavity, FIG. 2 is a schematic view of a surgical apparatus with a distal end inserted into the nasal cavity, FIG. 3 is a longitudinal sectional view of the apparatus, and FIG. 4 is an assembled perspective view. 5 is an exploded state diagram of the components.
An endoscope 10 that is a rigid endoscope constituting an observation apparatus has a main body portion 11 positioned outside the nasal cavity and an insertion portion 12 having a substantially circular cross section in which the distal end side is inserted from outside the nasal cavity into the nasal cavity of a living body. is doing. The distal end of the insertion portion 12 is inclined, and the objective lens 13 is attached thereto. A light guide 14 using an optical fiber or the like is inserted from an insertion port 11A formed on the side of the main body 11. The light guide 14 passes through the insertion portion 12 and faces the tip of the insertion portion 12. Light source device (not shown) light is incident on the light guide 14 and is emitted from the tip of the light guide 14 to the target part to illuminate the target part.

Reflected light at the target portion is incident from the objective lens 13, and is collected on, for example, an image guide 16 bundled with optical fibers, propagated through the image guide 16, and transmitted through the eyepiece 17. The surgeon observes the state of the target site through the finder 11B.

As the endoscope 10, in the case of intranasal surgery, a commercially available nasal endoscope can be used as it is. As the nasal scope in this case, specifically, those commercially available as “NASALSCOPE” series from Olympus Corporation can be used. A rigid endoscope made by WOLF or STRoz can also be used.
In addition, the surgeon performs the operation while observing the target site through the finder 11B during the operation. If necessary, an attachment made by Olympus Kogyo Co., Ltd. is attached to the viewfinder 11B, and the target site is projected as an image, and intranasal surgery can be performed while viewing the image.

When observing a target part using a rigid endoscope, light from the light source device is irradiated to the vicinity of the target part through the light guide 14, and this irradiation region is provided at the distal end of the insertion part 12 of the rigid endoscope. 13, the light is received by the image guide 16 and observed through the eyepiece 17 by the viewfinder 11 </ b> B. Alternatively, the light incident signal to the image guide 16 can be image-processed without being looked through the finder 11B and displayed on an appropriate CRT display device 15 to observe the image.

A tubular fluid path component 30 made of, for example, flexible plastic is attached to the outer peripheral surface of the insertion portion 12. The fluid path constituting member 30 is held by a holder 40. Therefore, the operator can hold the fluid path constituting member 30 and the endoscope 10 by holding the holder 40.

A supply joint 44 and a discharge joint 45 are fixed to the side of the holder 40. The supply joint 44 is connected to a reservoir 60 of physiological saline as a cleaning fluid via a supply line 61, and the discharge joint 45 is discarded via a discharge line 64 having a vacuum pump 63 in the middle. It is connected to the temporary storage tank 62. An operation hand switch 43 is provided on the upper portion of the holder 40. Reference numeral 65 denotes a flow rate adjusting knob.

As will be described in detail later, the supply pipe 61 communicates between the supply joint 44, the inside of the holder 40, the hand switch 43, and the wall of the fluid path component 30, and the endoscope 10. , And finally communicate with the nasal cavity.

On the other hand, the drainage pipe 64 communicates between the drainage joint 45, the inside of the holder 40, the wall of the fluid path constituting member 30, and the endoscope 10, and finally communicates with the nasal cavity. ing.

As a result, the physiological saline as the cleaning liquid is supplied into the nasal cavity from between the fluid path constituting member 30 and the endoscope 10 through the path, and is sucked into the nasal cavity by the suction force of the vacuum pump 63. Along with the mucus, the fluid is passed from the nasal cavity between the fluid path component 30 and the endoscope 10 and is discharged to the temporary storage tank 62 for disposal through the path.

The mounting state of the fluid path constituting member 30 with respect to the holder 40 is shown in FIGS. FIG. 3 shows a state where the insertion portion 12 of the endoscope 10 is further inserted into the fluid path constituting member 30.

The holder 40 has an outer cylinder 41 and an inner cylinder packing 42 inside thereof, and further has a hand switch 43 for operation. A supply joint 44 and a discharge joint 45 are integrated into a hole formed through the outer cylinder 41. A longitudinal through hole 42A is formed at the center of the inner cylinder packing 42, the fluid path constituting member 30 is inserted into the through hole 42A, and the insertion section 12 is inserted into the fluid path constituting member 30. The structure is such that the surgeon holds it integrally.

As shown typically in FIGS. 5 and 10, the fluid path constituting member 30 has a distal end portion 31 having an elliptical cross section and a proximal end portion 32 having a cylindrical shape. The base end portion 32 is press-fitted into the inner cylinder packing 42 and inserted until the flange portion of the base end portion 32 abuts against the end of the inner cylinder packing 42. In addition, a narrowing rib 32a having an inner diameter smaller than the outer diameter of the insertion portion 12 is formed at the base end portion 32, so that when the insertion portion 12 of the endoscope 10 is inserted, it is sealed in a liquid-tight manner. .

An annular groove 42B is formed on the outer peripheral surface of the inner cylinder packing 42 corresponding to the supply joint 44, and a communication hole 42C is formed toward the center. An annular groove 42D is formed at a position corresponding to the discharge joint 45, and a communication hole 42E toward the center is formed. Further, in the through hole 42A of the inner cylinder packing 42, three annular narrowing ribs 32a are formed at intervals in the longitudinal direction, and these ribs come into liquid-tight contact with the outer peripheral surface of the fluid path constituting member 30. Thus, a fluid supply partition 42F and a fluid discharge partition 42G that are liquid-tightly partitioned in the longitudinal direction are formed.

On the other hand, in the fluid path component member 30 with the fluid path component member 30 inserted into the through-hole 42A, the fluid path component member 30 is on the upper side at a position corresponding to the fluid supply partition path 42F and the fluid discharge partition path 42G in the longitudinal direction. A supply port 32A and a discharge port 32B are formed on the lower side through the wall.

As described above, the tip 31 of the fluid path component 30 has an elliptical tubular cross section. The short diameter of the inner surface of the ellipse is smaller than the outer diameter of the insertion portion 12 of the endoscope 10, and as a result, when the insertion portion 12 of the endoscope 10 is inserted into the distal end portion 31 while being deformed, the distal end The short-diameter portion of the portion 31 is in close contact with the outer peripheral surface of the insertion portion 12, and this is defined as a partition portion. Between the tip portion 31 and the insertion portion 12, a fluid supply gap 33 on one side and a fluid discharge gap on the opposite side. 34 is formed.

As shown in FIG. 10, the fluid supply gap 33 and the fluid discharge gap 34 open to the vicinity of the objective lens 13 in a state where the gap is secured to the tip, and communicate with the nasal cavity.

Next, the hand switch 43 for inflow of the cleaning fluid (saline) and its stop will be described in detail.

Now, as described above, taking intranasal surgery as an example, mucus such as mucus, blood, or pus is present as a contaminant in the nasal cavity, obstructing the operator's field of view with a rigid endoscope. If the operator's visual field is obstructed, there is a risk of damaging a portion other than the target surgical site with forceps. Therefore, if there is mucus in the target site, it is necessary to remove the mucus.

Therefore, in the present invention, the vacuum pump 63 is activated in order to remove mucus at an appropriate time point under the observation apparatus having the above-described configuration. This activation can be performed by connecting the vacuum pump 63 and a foot switch (not shown) and operating them. It can also be activated by an assistant.

When the vacuum pump 63 is activated, the negative pressure acts, and as a result, mucus in the nasal cavity is discharged from the discharge joint 45 through the fluid discharge gap 34, the discharge port 31B, the fluid discharge partition 42E, and the communication hole 42C in this order. It enters the pipe 64 and is discharged to the temporary storage tank 62 for disposal.

On the other hand, when mucus stains the objective lens 13 or the inside of the nasal cavity needs to be cleaned, a cleaning solution (physiological saline) is supplied from the storage bag 60. In this case, in addition to supplying by the negative pressure acting by the vacuum pump 63, preferably, a positive pressure is applied in the supply pipe 61 from the liquid storage bag 60.

In this state, when the operator presses the hand switch 43 of the holder 40, the closed valve portion 43H and the annular valve seat 43C1 are separated. As a result, the cleaning liquid in the liquid storage bag 60 flows into the concave groove 42B through the supply pipe 61 and the supply joint 44, and is then supplied from between the valve portion 43H and the annular valve seat 43C1. The fluid is supplied to the mouth 31A and the fluid supply partition 42D, and further flows into the nasal cavity through the fluid supply gap 33. The cleaning liquid that has flowed in is placed on the discharge flow in the vicinity of the objective lens 13 to clean the objective lens 13. Moreover, the target site | part from which mucus was discharged | emitted can be substituted with a washing | cleaning liquid. Therefore, the operator can clearly see the target site under a clear visual field.

When the removal of mucus is completed, when the switch 43 is released (the switch is turned off), the valve portion 43H is brought into line contact with the annular valve seat 43C1 by the repulsive force, and the supply of the cleaning liquid is stopped.

This cleaning operation is performed whenever necessary during the surgical process. When the operation is completed, the whole is extracted from the nasal cavity, and the endoscope 10 is extracted from the holder 40 and the fluid path component 30 and disinfected. Thereafter, the fluid path constituting member 30 is removed from the holder 40 and discarded and disinfected. In the next operation, the sterilized endoscope 10 is inserted into a new fluid path component 30.

On the other hand, in the example of the fluid path constituting member 30 described above, the tip 31 has a substantially elliptical cross section. Instead of the fluid path constituent member 30, as shown in FIG. 12, a fluid path constituent member 300 having a circular cross section can be used from the beginning. In this case, in order to partition the flow path,

partition projections

35 and 35 extending in the axial direction are formed on the inner surface of the fluid path component 300. The

partition projections

35 and 35 can be formed with the same material when the fluid path constituting member 300 is formed. Further, as another member, the fluid path constituting member 300 can be integrated. The fluid supply gap 33 and the fluid discharge gap 34 can be partitioned by the presence of the partition-

like protrusions

35 and 35.

The intranasal observation apparatus according to the present invention can be applied not only to intranasal surgery but also to surgery for various nasal cavities. Therefore, in the above example, a rigid endoscope for intranasal surgery has been described. However, an endoscope having another structure can be used depending on the type of surgery, and the structure of the fluid path constituent member is changed accordingly. be able to.

The insertion part of the endoscope can be rigid or flexible. When the insertion portion is flexible, naturally, a flexible member is used as the fluid path constituent member. As the fluid path constituent member, hard materials such as acrylic and polycarbonate can be used in addition to various plastics.

An example of the operation steps when cutting the posterior nasal nerve will be described in more detail. The approach to the foramen ostium preferably utilizes the posterior end of the middle nasal passage that allows sufficient working space for operation of the surgical probe. The butterfly palate is located at the canopy level at the rear end of the middle nasal passage side wall, that is, immediately behind the rear end of the horizontal part of the middle turbinate substrate. An incision is made in the posterior end mucosa of the middle nasal passage. In a normal rigid endoscope, it is difficult to reach the distal end of the instrument to the mucosa of the middle nasal passage due to the hindrance of the lower turbinate. Therefore, an incision can be made using a semiconductor laser by passing a quartz fiber having a diameter of 400 μm through a Rosen suction tube having an outer diameter of 2 mm with the tip bent.
After dying of the butterfly palate, the weakened Rosen's ear canal skin exfoliator used in otologic surgery was used, from the incision line to the level of the middle turbinate substrate in the form of a valve on the upper pelvic membrane Raise. When peeling to the upper edge of the palate, a U-shaped notch with an open top is usually observed. This is the butterfly palate hole (the butterfly palate notch), in which the butterfly palate artery wrapped in the periosteum runs.
Next, when the butterfly palatal artery is exposed, the periosteum is cut off along the butterfly palate arterial ridge with a flexible blunt needle for otologic surgery, and running underneath the periosteum while supplying and discharging the cleaning fluid. The butterfly palate artery with a diameter of 1.5-2 mm is exposed. When the artery is detached from the surrounding tissue while taking care not to damage the artery wall, one or two white cords having a diameter of about 0.5 mm accompanying the artery are exposed. This is the posterior nasal nerve.
Finally, regarding the cutting of the posterior nasal nerve, the posterior nasal nerve that has been peeled off is cut out by pulling it out using oat surgical forceps. To ensure nerve blockage, a laser is used to dissect the tissue surrounding the butterfly palatal artery. The butterfly palatal artery is preserved as much as possible, but if bleeding is observed during operation, the laser is removed. Use to solidify. Even if both butterfly palatal arteries are coagulated, there is no particular problem. Eventually, the periosteum valve is returned and an appropriate tampon is inserted to complete the operation.
As described above, the surgical probe of the present invention is not limited to forceps, a peeler, a blunt needle, a laser probe, or the like.

DESCRIPTION OF SYMBOLS 10 Endoscope 11 Main body part 12 Insertion part 15 CRT display device 17 Eyepiece 30 Fluid path component 40 Holder 42 Inner cylinder packing 43 Hand switch 60 Operation liquid storage 63 Vacuum pump 300 Fluid path component

Claims

A main body part located outside the nasal cavity, an insertion part in which the distal end part is inserted into the nasal cavity, an illumination means provided in the distal end part of the insertion part, and the light directly facing the nasal cavity A distal end portion of an endoscope having a translucent member that passes therethrough and an optical transmission path that gives optical information in the nasal cavity that passes through the translucent member to the outside, and surrounds the outer peripheral surface of the insertion portion Inserting the distal end of the tubular fluid path component provided in the state into the nasal cavity;
A space between the fluid path constituent member and the outer surface of the insertion portion is partitioned into a fluid supply gap and a fluid discharge gap, and a cleaning fluid is supplied to the fluid supply gap from outside the nasal cavity, and the cleaning fluid is supplied to the nasal cavity. Directing into the nasal cavity and draining the nasal irrigation fluid out of the nasal cavity through the fluid drainage gap with the nasal turbid fluid;
Inserting a surgical probe into the nasal cavity;
Exposing the posterior nasal nerve from surrounding tissue under observation with the endoscope and by supplying and draining lavage fluid;
Cutting with the surgical probe while exposing the nasal nerve from the surrounding tissue after exposure;
A method for surgically treating rhinitis symptoms characterized by comprising:
2. The method for surgically treating rhinitis symptoms according to claim 1, further comprising the step of discarding the fluid path component when the operation is completed.
A main body part located outside the nasal cavity, an insertion part in which the distal end part is inserted into the nasal cavity, an illumination means provided in the distal end part of the insertion part, and the light directly facing the nasal cavity A tubular tube in a state of surrounding the outer peripheral surface of the insertion portion of the endoscope having a translucent member that passes therethrough and an optical transmission path that provides optical information in the nasal cavity that passes through the translucent member to the outside. Removably assembling the fluid path components of
Inserting the endoscope and the tip of the fluid path component into the nasal cavity;
A space between the fluid path constituent member and the outer surface of the insertion portion is partitioned into a fluid supply gap and a fluid discharge gap, and a cleaning fluid is supplied to the fluid supply gap from outside the nasal cavity, and the cleaning fluid is supplied to the nasal cavity. Directing into the nasal cavity and draining the nasal irrigation fluid out of the nasal cavity through the fluid drainage gap with the nasal turbid fluid;
Inserting a surgical probe into the nasal cavity;
Exposing the posterior nasal nerve from surrounding tissue under observation with the endoscope and by supplying and draining lavage fluid;
Cutting with the surgical probe while exposing the nasal nerve from the surrounding tissue after exposure;
A method for surgically treating rhinitis symptoms characterized by comprising:
A first assembly step of detachably assembling a tubular fluid path constituent member in the through hole of the cleaning fluid access holder;
A main body part located outside the nasal cavity, an insertion part in which the distal end part is inserted into the nasal cavity, an illumination means provided in the distal end part of the insertion part, and the light directly facing the nasal cavity The insertion portion of the endoscope having a translucent member that passes therethrough and an optical transmission path that provides optical information in the nasal cavity that passes through the translucent member to the outside is inserted into the fluid path constituent member and assembled. Second assembly step;
Inserting the endoscope and the tip of the fluid path component into the nasal cavity;
A space between the fluid path constituent member and the outer surface of the insertion portion is partitioned into a fluid supply gap and a fluid discharge gap, and a cleaning fluid is supplied to the fluid supply gap from outside the nasal cavity, and the cleaning fluid is supplied to the nasal cavity. Directing into the nasal cavity and draining the nasal irrigation fluid out of the nasal cavity through the fluid drainage gap with the nasal turbid fluid;
Inserting a surgical probe into the nasal cavity;
Exposing the posterior nasal nerve from surrounding tissue under observation with the endoscope and by supplying and draining lavage fluid;
Cutting with the surgical probe while exposing the nasal nerve from the surrounding tissue after exposure;
A method for surgically treating rhinitis symptoms characterized by comprising:
5. The endoscope and the fluid path constituent member are integrally combined with a cleaning fluid entrance / exit holder, and the operator has a step of supplying, discharging and stopping the cleaning fluid while holding the holder. For surgical treatment of symptoms of rhinitis in children.
A tubular fluid path component;
A body part located outside the nasal cavity, an insertion part inserted into the nasal cavity, an illumination means provided in the distal part of the insertion part, and a translucent light passing directly through the nasal cavity An endoscope having a member and an optical transmission path for providing optical information in the nasal cavity passing through the translucent member to the outside, and wherein the insertion portion is detachably inserted into the fluid path constituent member; A fluid supply gap and a fluid discharge gap are defined between the fluid path component and the outer surface of the insertion portion, and the fluid supply gap and the fluid discharge gap are respectively located outside and inside the nasal cavity. Communication,
Fluid supply means is connected to the fluid supply gap to supply cleaning fluid from outside the nasal cavity and guide the cleaning fluid into the nasal cavity,
Fluid discharge means is connected to the fluid discharge gap to discharge the cleaning fluid in the nasal cavity together with the contaminant in the nasal cavity to the outside of the nasal cavity,
The outlet of the cleaning fluid in the fluid supply gap opens in the vicinity of the translucent member,
A device for surgically treating rhinitis symptoms characterized by the above.
Furthermore, it has a fluid inlet / outlet holder, and the fluid path constituting member is relatively detachably provided in the through hole of the holder,
A gap between the through hole of the holder and the outer surface of the fluid path constituent member is partitioned in a liquid-tight manner in the longitudinal direction to form a fluid supply path and a fluid discharge path,
In a state where the fluid path constituent member is inserted into the through hole of the holder, the supply port and the exhaust port have walls in positions corresponding to the fluid supply path and the fluid discharge path in the longitudinal direction. 7. The method for surgically treating a symptom of rhinitis according to claim 6, wherein the fluid supply path and the fluid discharge path are communicated with the fluid supply gap and the fluid discharge gap, respectively. apparatus.
The rhinitis symptom according to claim 7, wherein the holder is provided with a hand switch for operating an operator for stopping fluid supply into the fluid supply gap through the fluid supply path from the fluid supply means. A device for surgically treating.
The apparatus for surgically treating rhinitis symptoms according to claim 7, wherein the fluid path constituent member can be separated from the holder and the main body of the observation apparatus and discarded.