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JP2005131211A - 内視鏡用の外付けチャンネル - Google Patents

内視鏡用の外付けチャンネル Download PDF

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JP2005131211A
JP2005131211A JP2003372353A JP2003372353A JP2005131211A JP 2005131211 A JP2005131211 A JP 2005131211A JP 2003372353 A JP2003372353 A JP 2003372353A JP 2003372353 A JP2003372353 A JP 2003372353A JP 2005131211 A JP2005131211 A JP 2005131211A
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Koji Nakamoto
孝治 中本
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Olympus Corp
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Abstract

【課題】 外付けチャンネル本体の径の太径化を図った場合においても、外付けチャンネルを取り付けた内視鏡を体腔内において操作する際、外付けチャンネル本体から処置具等の突出量及び突出方向を確認可能にする。
【解決手段】 軟性式内視鏡1に設けられた挿入部に、着脱自在に併設され可撓性を有する外付けチャンネル2において、外付けチャンネル本体2aと、挿入部の先端に外付けチャンネル本体2aの先端部32を内視鏡観察視野内で確認可能に突出状態で取り付ける固定部30とを備える外付けチャンネル2及びこれを用いた内視鏡1を提供する。
【選択図】 図4












Description

本発明は、内視鏡本体に着脱可能な外付けチャンネル及びこれを備えた内視鏡に関するものである。
従来、人体の消化管内に挿入可能な内視鏡の用途は診断から治療へとその適用範囲は拡大している。また、治療内容も癌を切除する内視鏡的粘膜切除術,内視鏡的止血及び内視鏡的胃痩造設術など多様化しており、これら治療を行うための処置具を挿通する処置用チャンネルに求められる要求も多様化している。さらに、内視鏡の基本機能である患部洗浄,送気,送水等を行うためのチャンネルも重要である。
このような状況の中、多様化するこれら処置用チャンネルの要求に応えるため、従来の内視鏡を活用しながら効率的に治療を行うことを目的として、内視鏡の挿入部に着脱自在に併設される外付けチャンネルが考案されている。
この外付けチャンネルとして、例えば、外付けチャンネルに挿通されたポリープ回収用処置具が他の治療の作業性を向上させるため、外付けチャンネルの先端部を内視鏡観察視野に見えないように手元側に退避して設けたものが提案されている(例えば、特許文献1参照。)。
また、外付けチャンネルを容易に内視鏡の挿入部に装着でき、内視鏡の挿入部の外径に関わらず任意の位置および方向に取り付けられることを目的としたものも提案されている(例えば、特許文献2参照。)。この特許文献2に記載の外付けチャンネルは、先端部にシート状の可撓性を有する取付部を備え、この取り付け部の装着側に粘着層等の止着層を設けたものである。
さらに、可撓性を有する内視鏡の挿入部に外付けチャンネルを取り付けても挿入部の湾曲に対して柔軟に対応できるようにしたものも提案されている(例えば、特許文献3参照。)。この特許文献3に記載の外付けチャンネルは、外付けチャンネル本体の外周に凸部を設けるとともに、外付けチャンネルを内視鏡の挿入部に取り付けるための固定具に外付けチャンネル本体の可動を所定範囲内に規制する手段を設けたものである。
特開平11−192203号公報 実用考案登録第2558354号公報 実開昭58−28813号公報
しかしながら、上記従来の技術には以下のような課題が残されている。
内視鏡的治療への要求の高まりと適応拡大を考慮すると外付けチャンネル本体の管路径の拡大は今後重要になると考えられている。この場合、管路径の拡大により、外径の拡大された外付けチャンネル本体を備えた外付けチャンネルを内視鏡の挿入部に取り付けると、体腔内に挿入される外付けチャンネルを含む内視鏡の挿入部の直径はさらに太径化し、患者にかかる負担も大きくなる。
また、従来の技術はいずれにおいても、処置時における操作性の向上,外付けチャンネルの取り付け作業性の向上及び可動性の向上等の機能面に着眼されて考案されたものである。しかし、これらは、内視鏡の挿入部に装着される外付けチャンネル本体の径が小さい場合には有効であるが、外付けチャンネルの太径化に伴い、実質上の内視鏡挿入部も太くなってしまう。さらに、外付けチャンネルが手元側に退避した位置に設けられているため、外付けチャンネル本体から処置具等を目的の部位に突出させるのは困難である。
本発明は上述した事情に鑑みてなされたものであって、外付けチャンネル本体の径の太径化を図った場合においても、外付けチャンネルを取り付けた内視鏡を体腔内において操作する際、外付けチャンネル本体から処置具等の突出量及び突出方向を確認することが可能となる外付けチャンネル及びこれを備えた内視鏡を提供ことを目的とする。
上記目的を達成するために、本発明は、以下の手段を提供する。
本発明の外付けチャンネルは、軟性式内視鏡に設けられた挿入部に、着脱自在に併設され可撓性を有する外付けチャンネルにおいて、外付けチャンネル本体と、前記挿入部の先端に前記外付けチャンネル本体の先端部を内視鏡観察視野内で確認可能に突出状態で取り付ける固定部とを備えることを特徴とする。
この発明によれば、外付けチャンネルの先端部が内視鏡観察視野から確認できる位置に配されているため、外付けチャンネル本体内部に把持鉗子等の処置具を挿通させた際、処置具の突出方向及び突出量を確認することが可能となる。
また、本発明の外付けチャンネルは、前記固定部に対して前記外付けチャンネル本体がその基端側へ移動をすること規制する固定手段を設けることが好ましい。
この発明によれば、固定手段を設けることにより、固定部に対する外付けチャンネル本体の移動が規制されることになるため、外付けチャンネル本体の固定部からの最小突出量を規定することができる。したがって、外付けチャンネル本体を内視鏡観察画面で常に確認しながら処置を行うことができる。
また、本発明の外付けチャンネルは、前記内視鏡視野内に表示される前記先端部の大きさを内視鏡観察視野の5分の1以下とすることが好ましい。
この発明によれば、内視鏡挿入時に必要な視野は十分に確保した状態で、病変部位等の処置を行うことができる。
また、本発明の外付けチャンネルは、前記外付けチャンネル本体が、吸引,送気,送水及び処置具の挿通を行う機能を有することが好ましい。
この発明によれば、外付けチャンネル本体に多機能を持たせることにより、外付けチャンネル本体を通じて様々な処置を行うことができるため、機能性に優れた装置にすることが可能となる。
本発明の内視鏡は、上記本発明の外付けチャンネルを備えていることを特徴とする。
この発明によれば、内視鏡によって体腔内を観察しながら、外付けチャンネルに処置具等を挿入し病変部位等の処置を行うことが可能となる。
本発明に係る外付けチャンネルによれば、外付けチャンネル本体の先端部を内視鏡観察視野内で確認できる位置に設けることによって、体腔内を処置している際、外付けチャンネル本体を常に術者が確認できる。したがって、処置具の突出方向及び突出量を確認しながら処置を行うことができるため、目的の部位に処置具等を突出させることが可能となる。
以下、本発明の第1実施形態に係る外付けチャンネルについて図1から図9を参照して説明する。
本実施形態に係る内視鏡1は、図1に示す内視鏡1の本体に、図2に示す外付けチャンネル2を装着させて使用するものである。
内視鏡1の本体は、図1に示すように、可撓性の挿入部11を有しており、これは、硬質の内視鏡先端部12と、この内視鏡先端部12の基端に設けられた湾曲自在の湾曲部13と、この湾曲部13の後端から内視鏡操作部14まで伸びる長尺の可撓管部15とから構成されている。
内視鏡先端部12には、CCD(図示略)に観察画像を結像するための観察窓16と、暗い体腔内に照明光を照射する照明窓17と、観察窓16に付着した体液等を取り除くためのノズル18と、吸引,把持鉗子等の処置具等を挿通し処置を行うためのチャンネル19とが設けられている。
内視鏡操作部14には、内視鏡先端部12に設けられたノズル18に空気や水を送り込む操作を行うための送気・送水ボタン20と、チャンネル19からの吸引操作を行うための吸引ボタン21と、湾曲部13を上下における任意の方向に湾曲操作するアングルノブ22と、先端側には可撓管部15内に配設されチャンネル19に連通した処置具を挿入するための処置具挿入口部23とが設けられている。
また、観察窓16により観察した画像は、図5に示すように、内視鏡観察画面24に表示されるようになっている。
外付けチャンネル2は、図2に示すように、内視鏡1の本体の挿入部11と略同程度の長さを有する外付けチャンネル本体2aと、内視鏡先端部12に装着可能に形成された先端固定部(固定部)30と、外付けチャンネル本体2aに対して係合しプラスチック等の樹脂からなる複数の係止部31とを備えている。
外付けチャンネル本体2aの手元側には、外付けチャンネル本体2a内部に処置具を挿入したり、吸引のための三方活栓性体を取り付けたりするためのチャンネル口金35が接着などで固定されて取り付けられている。また、外付けチャンネル本体2aの先端側に設けられ開口部を有する先端開口部(先端部)32の外周部は、図3に示すように、r状の面取りが施されており、外付けチャンネル2を内視鏡1の本体に取り付けて体腔内に挿入する際に体壁を傷つけないような配慮がなされた構成になっている。
先端固定部30は、外付けチャンネル本体2aに対して接着などで固定されゴム等の弾性体からなっている。また、外付けチャンネル本体2aの材質としては、ポリフッ化エチレン等のフッ素樹脂,塩化ビニル及びウレタン等の比較的柔軟に湾曲可能な樹脂材料によって形成されている。
係止部31は、内視鏡1の本体の湾曲部13及び可撓管部15に係合可能なC字状のアーム部31aと、外付けチャンネル本体2aが挿通されるガイド部31bとを備えている。
次に、外付けチャンネル2を内視鏡1の本体に取り付ける方法について図4から図6を参照して説明する。
まず、先端固定部30を内視鏡先端部12に取り付ける方法を説明する。図4(a)示すように、内視鏡先端部12が装着される先端固定部30の開口部33の内径aと内視鏡先端部12の外径bとの寸法関係をa<bに設定している。このため、先端固定部30を内視鏡先端部12に装着した場合、弾性体による締め付け力によって強固に固定される。また、先端固定部30の先端側には突き当て面34が設けられており、さらに、先端固定部30からの外付けチャンネル本体2aの突出量をあらかじめ所定の設定寸法cに固定している。このため、突き当て面34を内視鏡先端部12に突き当たるまで挿入することによって装着することにより、内視鏡先端部12からの外付けチャンネル本体2aの突出量も一定に保つことが可能となっている。
このとき、図4(b)に示すように、観察窓16の視野角はθであり、図5に示すように、内視鏡観察画面24における内視鏡視野dに対する先端開口部32の突出量eは5分の1以下に抑えられており、内視鏡挿入時に必要な視野は十分に確保できている。
次に、係止部31を内視鏡1本体の湾曲部13及び可撓管部15に取り付ける方法を説明する。図6に示すように、アーム部31aの開口幅gと湾曲部13及び可撓管部15の外径hとの寸法関係をg<hに設定しているため、係止部31を湾曲部13及び可撓管部15に装着しようとした場合、図6の(b)に示すように、湾曲部13及び可撓管部15の外径hより小さい開口幅gのC字状のアーム部31aが弾性変形によって湾曲部13及び可撓管部15と嵌合可能となる。これにより、装着後は容易に係止部31が湾曲部13及び可撓管部15から外れることはない構成となっている。
また、ガイド部31bの内径には、図6(a)に示すように、外付けチャンネル本体2aの挿入時にすき間fを設定している。したがって、図7に示すように、外付けチャンネル本体2aの後端側はフリーであり、ガイド部31b間を軸方向に移動可能であるため、外付けチャンネル本体2aが先端固定部30を経由して内視鏡先端部12に固定されている状態で湾曲操作を行っても抵抗感のないスムースな湾曲操作を行うことが実現できる。
次に、以上の構成からなる本実施形態の外付けチャンネル及び内視鏡の使用方法について図8を参照して、以下に説明する。
まず、外付けチャンネル2の先端固定部30の開口部33に内視鏡先端部12を装着し、内視鏡1の本体の挿入部11にアーム部31aを装着する。内視鏡1の本体の挿入部11を体腔内に挿入した後、目的の病変に到達したところで、内視鏡1の本体のチャンネル19内に高周波メス41を挿通させ、外付けチャンネル本体2a内部に把持鉗子40を挿通する。
次に、内視鏡観察画面24に患部をとらえた際、把持鉗子40及び高周波メス41をそれぞれから突出させ、高周波メス41により切開した粘膜42を把持鉗子40で持ち上げながら粘膜の下層を切除する。
すなわち、本実施形態に係る外付けチャンネル2及び内視鏡1によれば、外付けチャンネル2の先端開口部32が内視鏡観察画面24から確認できる位置に配されているため、把持鉗子40等の処置具の突出方向及び突出量が確認でき、目的の部位に把持鉗子40等の処置具を突出させることが可能となる。また、操作性に優れた内視鏡的粘膜切除術を提供することができる。
なお、本実施形態において、積極的に体壁を傷付けないようにするには、図9に示すように、先端開口部32が外周に進むにしたがって傾斜した形状とすることにより可能となる。
次に、本発明の第2実施形態に係る外付けチャンネル及び内視鏡について図10から図13を参照して説明する。
本実施形態に係る外付けチャンネル50及び内視鏡1において、外付けチャンネル50と内視鏡1の係止手段として係止部51が薄膜状のカバー部52を用いたこと及びガイド部53を備える点及び外付けチャンネル50にストッパ部(固定手段)54が形成されている点で第1の実施形態と相違している。
カバー部52は、図10に示すように、外付けチャンネル50の先端固定部30の後端側に設けられており、接着等により強固に先端固定部30に固定されている。ガイド部53は、アーチ状にカバー部52に複数個取り付けられている。これらにより、カバー部52とガイド部53との間に外付けチャンネル本体50aが移動可能な状態で挿通されている。
また、カバー部52は、挿入部11と略同程度の長さを有し、また、略同程度の内径を有しているため、湾曲部13及び可撓管部15を被覆可能となっている。さらに、カバー部52の後端部は、図12に示すように、手術用のテープ等の粘着テープ56によって内視鏡1の挿入部11に固定可能となっている。
先端固定部30には挿通部30aが設けられており、この挿通部30aは外付けチャンネル本体50aを挿通可能とし、外付けチャンネル本体50aが摺動可能な内径となっている。
ストッパ部54は、外付けチャンネル本体50aの先端側の外周に突出して形成されており、接着などにより外付けチャンネル本体50aに対して固定されている。これにより、外付けチャンネル本体50aの先端固定部30からの最小突出量は規制されている。すなわち、開口部32からiの位置にストッパ部54を設けることにより、先端固定部30を内視鏡先端部12に固定した場合、図11に示すように、内視鏡先端部12からの最小突出量をiとして規制することが可能となる。このとき、観察窓16の視野角はθであり、外付けチャンネル本体50aを内視鏡観察画面24で確認できる寸法に設定している。
次に、外付けチャンネル50を内視鏡1に取り付ける方法について図12を参照して説明する。
まず、外付けチャンネル50の先端固定部30と内視鏡先端部12とを第1実施形態と同様に取り付ける。次に、カバー部52を内視鏡1の本体の挿入部11の全長にわたって被覆し、後端部は粘着テープ56によって固定する。
次に、以上の構成からなる本実施形態の外付けチャンネル50及び内視鏡1の使用方法について図13を参照して、以下に説明する。
まず、外付けチャンネル50の先端固定部30を装着し、カバー部52を装着する。そして、内視鏡1の挿入部11を体腔内に挿入し、内視鏡1のチャンネル19内に止血用ヒートプローブ55を挿通する。
次に、体腔内の患部の止血を行う際、外付けチャンネル本体50aを出血部位に押し出し、血液を吸引する。そして、内視鏡観察画面24で患部を確認しながら、内視鏡1の本体のチャンネル19に挿通した止血用ヒートプローブ55により止血を行う。
すなわち、本実施形態に係る外付けチャンネル50及び内視鏡1によれば、外付けチャンネル本体50aを最小突出量i以上であれば任意の軸方向に位置させることが可能となる。したがって、外付けチャンネル本体50aを内視鏡観察画面24で必ず確認できる位置において軸方向の移動が可能となるため、目的の部位に処置具等を突出させ、その突出量及び突出方向を確認しながら処置を行うことが可能な内視鏡的処置を提供することができる。また、複数個の係止部を挿入部11に装着する必要がないので、外付けチャンネル50を内視鏡1の本体に取り付ける作業がより簡便になる。
次に、本発明の第3実施形態に係る外付けチャンネル及び内視鏡について図14を参照して説明する。
本実施形態に係る外付けチャンネル60及び内視鏡1において、外付けチャンネル60の先端固定部(固定手段)61の形状で第1,第2の実施形態と相違している。
先端固定部61は、外付けチャンネル本体60aの先端に設けられ切り欠き部62aが形成された固定部62と、溝部12aが形成された内視鏡先端部12bと、熱収縮チューブからなるバンド部63とを備えている。この切り欠き部62a及び溝部12aは、固定部62及び内視鏡先端部12bの外周の約半周にわたって設けられており、長さ方向の幅が略同寸法に設定されている。また、固定部62は、図14(b)に示すように、先端開口部32を内視鏡1の本体の観察窓16から確認できる位置に固定されている。
バンド部63は、外周の一部に設けられた把持部63aと、把持部63aの両端に設けられた切り溝部63bとから構成されている。
ここで、外付けチャンネル本体60aの先端部を内視鏡先端部12に取り付ける場合、切り欠き部62aと溝部12aとにバンド部63を被覆し、バンド部63を過熱し収縮させて、外付けチャンネル本体60aの先端部と内視鏡先端部12とを固定する。
一方、外付けチャンネル本体60aの先端部と内視鏡先端部12とを取り外す場合、把持部63aを摘んで切り溝部63bに沿う方向に引っ張ることによって、バンド部63を破損させ、外付けチャンネル本体60aの先端部と内視鏡先端部12とを取り外すことが可能となる。
すなわち、本実施形態に係る外付けチャンネル60及び内視鏡1によれば、外付けチャンネル60を内視鏡観察画面24で必ず確認できる位置に設定することが可能となる。また、外付けチャンネル本体60aの先端部と内視鏡先端部12とがバンド部63により固定されているため、外付けチャンネル本体60aの先端部と内視鏡先端部12との取り付け及び取り外しを容易に行うことが可能となる。
なお、本実施形態において、バンド部63として熱収縮チューブを用いたが、外付けチャンネル本体60aの先端部と内視鏡先端部12とを圧着できれば良いため、例えば、ゴム等の弾性材料を有するものであっても良い。
また、本発明の技術範囲は上記実施の形態に限定されるものではなく、本発明の趣旨を逸脱しない範囲において種々の変更を加えることが可能である。
本発明の第1実施形態に係る内視鏡を示す斜視図である。 本発明の第1実施形態に係る外付けチャンネルを示す斜視図である。 本発明の第1実施形態に係る外付けチャンネルの先端開口部を示す断面図である。 本発明の第1実施形態に係る外付けチャンネルの先端固定部を内視鏡先端部に(a)取り付ける前、(b)取り付けた後の状態を示す要部を破断した断面図である。 本発明の第1実施形態に係る外付けチャンネルを内視鏡の本体に取り付けた後、内視鏡観察画面の映像を示す模式図である。 本発明の第1実施形態に係る外付けチャンネルの係止部を内視鏡湾曲部及可撓管部に(a)取り付ける前、(b)取り付けた後の状態を示す要部を破断した断面図である。 本発明の第1実施形態に係る外付けチャンネルを内視鏡に取り付けて湾曲部を湾曲させた状態を示す要部を破断した断面図である。 本発明の第1実施形態に係る外付けチャンネル及び内視鏡を用いて内視鏡的粘膜切除術を示す斜視図である。 図3に示す外付けチャンネルの先端開口部を変形例を示す断面図である。 本発明の第2実施形態に係る外付けチャンネルを示す斜視図である。 本発明の第2実施形態に係る外付けチャンネルの先端固定部を内視鏡先端部に取り付けた後の状態を示す要部を破断した断面図である。 本発明の第2実施形態に係る外付けチャンネルを内視鏡の本体に取り付けた状態を示す斜視図である。 本発明の第2実施形態に係る外付けチャンネル及び内視鏡を用いて内視鏡的止血術を示す斜視図である。 本発明の第3実施形態に係る外付けチャンネルの先端部を内視鏡先端部に(a)取り付ける前、(b)取り付けた後の状態を示す斜視図である。
符号の説明
d 内視鏡観察視野
1 内視鏡
2,50,60 外付けチャンネル
2a,50a,60a 外付けチャンネル本体
11 内視鏡挿入部
30 先端固定部(固定部)
32 先端開口部(先端部)
54 ストッパ部(固定手段)
61 先端固定部(固定手段)

Claims (5)

  1. 軟性式内視鏡に設けられた挿入部に、着脱自在に併設され可撓性を有する外付けチャンネルにおいて、
    外付けチャンネル本体と、
    前記挿入部の先端に前記外付けチャンネル本体の先端部を内視鏡観察視野内で確認可能に突出状態で取り付ける固定部とを備えることを特徴とする内視鏡用の外付けチャンネル。
  2. 前記固定部に対して前記外付けチャンネル本体がその基端側へ移動をすること規制する固定手段を設けたことを特徴とする請求項1に記載の内視鏡用の外付けチャンネル。
  3. 前記内視鏡視野内に表示される前記先端部の大きさを内視鏡観察視野の5分の1以下としたことを特徴とする請求項1または請求項2に記載の内視鏡用の外付けチャンネル。
  4. 前記外付けチャンネル本体が、吸引,送気,送水及び処置具の挿通を行う機能を有することを特徴とする請求項1から請求項3のいずれか1項に記載の内視鏡用の外付けチャンネル。
  5. 請求項1から請求項4のいずれか1項に記載の外付けチャンネルを備えていることを特徴とする内視鏡。

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