JP3864280B2 - Double balloon endoscope device - Google Patents

Description

  The present invention relates to an endoscope apparatus, and more particularly to an endoscope apparatus having an endoscope in which a balloon is attached to the distal end of an insertion portion and an insertion assisting tool for guiding the insertion portion of the endoscope into a body cavity.

  When inserting the insertion part of the endoscope into the deep digestive tract such as the small intestine, simply inserting the insertion part makes it difficult for force to be transmitted to the distal end of the insertion part due to the complicated bending of the intestinal tract. Have difficulty. Therefore, an insertion aid called an overtube or a sliding tube is attached to the insertion portion of the endoscope and inserted into the body cavity, and the insertion portion is guided by this insertion aid, so that the extra portion of the insertion portion is inserted. An endoscope apparatus that prevents bending and bending has been proposed (for example, Patent Document 1).

  As a conventional endoscope apparatus, there is known a double balloon type endoscope apparatus in which a first balloon is provided at a distal end portion of an endoscope insertion portion and a second balloon is provided at a distal end portion of an insertion assisting tool. (For example, Patent Document 2 and Patent Document 3).

In the double balloon type endoscope apparatus, the insertion portion and the insertion assisting tool are inserted into the intestinal tract for a predetermined length, the first and second balloons are inflated and the first and second balloons are fixed to the intestinal wall, There is a case where an operation of contracting the bent intestine straightly is performed by pulling the insertion portion and the insertion aid simultaneously. Thereafter, by repeatedly performing the insertion operation of the insertion portion and the insertion aid and the hand pulling operation, the intestinal tract is pulled and the insertion portion is inserted into the target site.
JP-A-10-248794 JP 2001-340462 A JP 2002-301019 A

  An endoscope apparatus equipped with a balloon is configured such that the pressure of the balloon is set to an appropriate pressure for fixing the balloon to the intestinal wall. When the air pressure is inflated, the balloon cannot be raised to an appropriate pressure. Balloon pressure control is an important matter as is apparent from the treatment technique, and this pressure control is performed by a balloon control device provided separately from the endoscope. However, when the tube in the middle is inflated as described above, the actual pressure of the balloon does not reach the appropriate pressure, although the appropriate pressure is indicated on the balloon control device side. Further, the pressure received by the balloon from the intestinal wall is detected by the balloon control device via the balloon and the tube, but in this case as well, the pressure cannot be accurately detected when the tube is inflated.

  The present invention has been made in view of such circumstances, and an object of the present invention is to provide an endoscope apparatus that can accurately detect the pressure of the balloon and the pressure of the body cavity wall received by the balloon.

In order to achieve the above object , the present invention is provided with a first inflatable balloon that is attached to the outer periphery of the distal end of the endoscope insertion portion, and a second balloon that is inflatable and inflatable at the outer periphery of the distal end. An insertion assisting tool that is inserted through the endoscope insertion portion and serves as a guide when the endoscope insertion portion is inserted, a first air supply conduit that has one end connected to the first balloon, and one end that is connected to the second balloon A second air supply line to be connected and the other ends of the first air supply line and the second air supply line are connected, and air is supplied to and sucked from the first balloon and the second balloon. And a balloon control device that controls the expansion and contraction of the second balloon, wherein the first air supply conduit includes an air supply tube inserted into the endoscope insertion portion, and the air A supply tube and the balloon control device; The anti-air pressure of the air supply tube inserted through the endoscope insertion portion with respect to the anti-air pressure of the tube forming the connecting tube and forming the second air supply conduit is The air pressure of the first balloon and the second balloon is low, and the air pressure resistance is low . Here, air pressure resistance is defined as low air pressure resistance when the degree of deformation relative to pressure is large, or when the pressure at which deformation starts is small, and when the degree of deformation relative to pressure is small or When the starting pressure is large, it is defined that the air pressure resistance is large.
Further, according to the present invention, the air supply tube inserted through the endoscope insertion portion is made of polytetrafluoroethylene, and the tube forming the connection tube and the second air supply conduit is made of silicon rubber. It is characterized by.
Further, according to the present invention, the balloon control device instructs a pump for supplying and sucking air to the first balloon and the second balloon, and supplying, sucking and maintaining pressure of the air to the first balloon and the second balloon. And a pressure sensor for detecting the pressure of the first balloon and the second balloon, and the pump is driven and controlled based on the operation of the switch and the output of the pressure sensor .

  The invention according to claim 1 is an endoscope in which a balloon is attached to the outer peripheral portion of the distal end of the insertion portion, and an insertion aid for guiding the insertion portion of the endoscope, and whether or not the balloon is attached. Is intended for an endoscope apparatus including an insertion aid not specifically mentioned. That is, this insertion aid includes an overtube that is inserted orally and a sliding tube that is inserted transanally.

  In such an endoscope apparatus, since the air pressure resistance of the air supply line for supplying air from the pump to the balloon is set to be larger than the air pressure resistance of the balloon, the air supply line does not inflate. There is no problem that swells. Therefore, the pressure of the balloon is accurately detected by the pressure sensor of the balloon control device. In addition, the air supply conduit is not affected at all by the pressure fluctuation generated when the balloon is deflated by the pressure from the body cavity wall. Therefore, the pressure of the body cavity wall received by the balloon is accurately detected by the pressure sensor of the balloon control device. If the existing material is not changed to a hard material, the air supply line may be made thicker, covered with a net, or embedded with a net to increase air pressure resistance.

  In such an endoscope apparatus, the air pressure resistance of the first air supply conduit for supplying air from the pump to the first balloon is set to be larger than the air pressure resistance of the first balloon, and the second balloon In addition, the air pressure resistance of the second air supply line for supplying air from the pump is set to be larger than the air pressure resistance of the second balloon. For this reason, the first and second air supply conduits do not inflate without inflating the first and second balloons, whereby the pressure of the first and second balloons is controlled by the pressure sensor of the balloon control device. It is detected accurately. Further, the first and second air supply conduits are not affected at all by the pressure fluctuation that occurs when the first and second balloons are deflated by the pressure from the body cavity wall. Therefore, the pressure of the body cavity wall received by the first and second balloons is accurately detected by the pressure sensor of the balloon control device.

  According to the endoscope apparatus of the present invention, since the air pressure resistance of the air supply line for supplying air from the pump to the balloon is set to be larger than the air pressure resistance of the balloon, the air supply line is inflated with the balloon. It is not affected at all by the pressure fluctuation due to the contraction, so that the pressure of the balloon can be accurately detected.

  Hereinafter, preferred embodiments of an endoscope apparatus according to the present invention will be described with reference to the accompanying drawings.

  FIG. 1 is a system configuration diagram of an endoscope apparatus according to the present invention. The endoscope apparatus shown in FIG. 1 includes an endoscope 10, an overtube (insertion aid) 50, and a balloon control device 100.

  The endoscope 10 includes a hand operation unit 14 and an insertion unit 12 connected to the hand operation unit 14. A universal cable 15 is connected to the hand operation unit 14, and a connector (not shown) connected to a processor or a light source device (not shown) is provided at the end of the universal cable 15.

  The hand operation unit 14 is provided with an air / water supply button 16, a suction button 18, and a shutter button 20 that are operated by an operator, and a pair of angle knobs 22, 22 and a forceps insertion unit 24 are respectively provided. It is provided in the position. Further, the hand operation unit 14 is provided with a balloon air supply port 26 for supplying air to the first balloon 30 and sucking air from the balloon 30.

  The insertion portion 12 includes a flexible portion 32, a bending portion 34, and a distal end portion 36. The bending portion 34 is configured by connecting a plurality of node rings so as to be able to bend, and is remotely operated by a turning operation of a pair of angle knobs 22, 22 provided on the hand operation portion 14. Thereby, the front end surface 37 of the front end portion 36 can be directed in a desired direction.

  As shown in FIG. 2, the distal end surface 37 of the distal end portion 36 is provided with an objective optical system 38, an illumination lens 40, an air / water feeding nozzle 42, a forceps port 44, and the like at predetermined positions. 2 and 3, an air supply / suction port 28 is provided on the outer peripheral surface of the distal end portion 36. The air supply / suction port 28 has an inner diameter 0. It communicates with the balloon air inlet 26 of FIG. 1 through an air supply tube 29 of about 8 mm. Therefore, air is blown out from the air supply / suction port 28 of the tip 36 by supplying air to the balloon supply port 26, while air is sucked out from the air supply / suction port 28 by sucking air from the balloon supply port 26. Air is aspirated.

  As shown in FIG. 1, a first balloon 30 made of an elastic material such as rubber is detachably attached to the distal end portion 36 of the insertion portion 12. As shown in FIG. 3, the first balloon 30 is formed of a central bulging portion 30c and attachment portions 30a and 30b at both ends thereof, and the air supply / suction port 28 is positioned inside the bulging portion 30c. It is attached to the tip 36 side. The attachment portions 30a and 30b are formed to have a diameter smaller than the diameter of the tip portion 36, and after being in close contact with the tip portion 36 with its elastic force, a thread (not shown) is wound and fixed. In addition, it is not limited to the winding fixation of a thread | yarn, You may fix the attaching parts 30a and 30b to the front-end | tip part 36 by fitting a fixing ring in the attaching parts 30a and 30b.

  The first balloon 30 attached to the distal end portion 36 is inflated into a substantially spherical shape by blowing air from the air supply / suction port 28 shown in FIG. On the other hand, when the air is sucked from the air supply / suction port 28, the bulging portion 30 c contracts and is brought into close contact with the outer peripheral surface of the tip portion 36.

  The overtube 50 shown in FIG. 1 is formed of a tube main body 51 and a grip portion 52. The tube body 51 is formed in a cylindrical shape as shown in FIG. 4 and has an inner diameter slightly larger than the outer diameter of the insertion portion 12. The tube body 51 is configured by covering the outside of a flexible resin tube made of urethane or the like with a lubrication coat and covering the inside with a lubrication coat. In addition, the insertion part 12 is inserted toward the tube main body 51 from the base end opening part 52A of the holding part 52 as shown in FIG.

  As shown in FIG. 1, a balloon air supply port 54 is provided on the proximal end side of the tube main body 51. An air supply tube 56 having an inner diameter of about 1 mm is connected to the balloon air supply port 54, and the tube 56 is bonded to the outer peripheral surface of the tube main body 51 and extends to the distal end portion of the tube main body 51.

  The distal end 58 of the tube body 51 is formed in a tapered shape. A second balloon 60 made of an elastic body such as rubber is attached to the proximal end side of the distal end 58 of the tube main body 51. The second balloon 60 is mounted in a state where the tube main body 51 passes therethrough, and includes a central bulging portion 60c and attachment portions 60a and 60b at both ends thereof as shown in FIG. The distal end side attachment portion 60a is folded inside the bulging portion 60c, and the folded attachment portion 60a is fixed to the tube main body 51 by winding the X-ray contrast yarn 62. The proximal-side attachment portion 60 b is disposed outside the second balloon 60, and is fixed to the tube body 51 by winding a thread 64.

  The bulging portion 60c is formed in a substantially spherical shape in a natural state (a state in which neither is inflated nor contracted), and its size is larger than a size in a natural state (a state in which neither is expanded nor contracted) of the first balloon 30. Largely formed. Therefore, when air is supplied to the first balloon 30 and the second balloon 60 at the same pressure, the outer diameter of the bulging portion 60c of the second balloon is larger than the outer diameter of the bulging portion 30c of the first balloon 30. . For example, when the outer diameter of the first balloon 30 is φ25 mm, the outer diameter of the second balloon 60 is configured to be φ50 mm.

  The above-described tube 56 is opened inside the bulging portion 60c, and an air supply / suction port 57 is formed. Therefore, when air is supplied from the balloon air supply port 54, air is blown out from the air supply / suction port 57, and the bulging portion 60c is expanded. When air is sucked from the balloon air supply port 54, air is sucked from the air supply suction port 57, and the second balloon 60 is deflated. 5 is an injection port for injecting a lubricating liquid such as water into the tube main body 51. The injection port 66 is connected to the proximal end of the tube main body 51 via a small-diameter tube 68. It communicates with the club side.

  On the other hand, the balloon control device 100 of FIG. 1 is a device that supplies and sucks fluid such as air to the first balloon 30 and supplies and sucks fluid such as air to the second balloon 60. The balloon control device 100 includes a device main body 102 having a pump, a sequencer, and the like (not shown) and a hand switch 104 for remote control.

  On the front panel of the apparatus main body 102, a power switch SW1, a stop switch SW2, a pressure gauge 106 for the first balloon 30 and a pressure gauge 108 for the second balloon 60 are provided. Further, a tube 110 that supplies and sucks air to the first balloon 30 and a tube 120 that supplies and sucks air to the second balloon 60 are attached to the front panel of the apparatus main body 102. Reservoir tanks 130 and 140 for collecting body fluids flowing back from the first balloon 30 and the second balloon 60 when the first balloon 30 and the second balloon 60 are broken are respectively provided in the middle of the tubes 110 and 120. Provided.

  On the other hand, the hand switch 104 holds the same stop switch SW3 as the stop switch SW2 on the apparatus main body 102 side, the ON / OFF switch SW4 that supports pressurization / decompression of the first balloon 30, and the pressure of the first balloon 30. There is provided a pause switch SW5 for holding, an ON / OFF switch SW6 for supporting pressurization / depressurization of the second balloon 60, and a pause switch SW7 for holding the pressure of the second balloon 60. The hand switch 104 is electrically connected to the apparatus main body 102 via a cable 150.

  The balloon control device 100 configured as described above supplies air to the first balloon 30 and the second balloon 60 to inflate them, and controls the air pressure to inflate the first balloon 30 and the second balloon 60. Keep in state. In addition, air is sucked and contracted from the first balloon 30 and the second balloon 60, and the air pressure is controlled to hold the first balloon 30 and the second balloon 60 in a contracted state.

  Further, the apparatus main body 102 is provided with a pressure sensor that indirectly detects the pressure of the first balloon 30 and the second balloon 60. The pressure sensor includes a pressing force (for example, a pressure 5.6 kilopascals (Kpa) higher than the atmospheric pressure) for appropriately fixing the first balloon 30 and the second balloon 60 to the intestinal wall, and the pressing force. A high abnormal pressure and a preset negative pressure are detected. The apparatus main body 102 controls the pump based on the pressures of the first balloon 30 and the second balloon 60 detected by the pressure sensor.

  By the way, in the endoscope apparatus of the embodiment, the first balloon 30 and the second balloon 60 are made of soft natural rubber, and an air supply tube (first air supply conduit) 29 inserted through the insertion portion 12 is: Made of soft Teflon (polytetrafluoroethylene) so as not to affect the flexibility of the insertion portion 12, a tube (first air supply conduit) 110, a tube (second air supply conduit) 120, and an air supply tube The (second air supply duct) 56 is made of strong silicon because it is exposed to the outside. Based on these materials, the air supply pipes are compared from the viewpoint of air pressure resistance. The Teflon air supply tubes (first air supply pipes) 29, then the silicon tubes 110 and 120, and the air supply are arranged in descending order. The tube 56, then the first balloon 30 and the second balloon 60 made of natural rubber are arranged in this order.

  Next, an operation method of the endoscope apparatus will be described with reference to FIGS.

  First, as shown in FIG. 5A, the insertion portion 12 is inserted into the intestinal tract (for example, the descending leg of the duodenum) 70 with the overtube 50 placed on the insertion portion 12. At this time, the first balloon 30 and the second balloon 60 are deflated.

  Next, as shown in FIG. 5B, the second balloon 60 is inflated by supplying air to the second balloon 60 in a state where the distal end 58 of the overtube 50 is inserted to the bent portion of the intestinal tract 70. As a result, the second balloon 60 is locked to the intestinal tract 70, and the tip 58 of the overtube 50 is fixed to the intestinal tract 70.

  Next, only the insertion part 12 of the endoscope 10 is inserted into the deep part of the intestinal tract 70 as shown in FIG. Then, as shown in FIG. 5D, air is supplied to the first balloon 30 to be inflated. Thereby, the first balloon 30 is fixed to the intestinal tract 70. At that time, since the first balloon 30 is smaller than the second balloon 60 when inflated, the burden on the intestinal tract 70 is small, and damage to the intestinal tract 70 can be prevented.

  Next, after the air is sucked from the second balloon 60 to contract the second balloon 60, the overtube 50 is pushed in and inserted along the insertion portion 12 as shown in FIG. And after pushing the front-end | tip 58 of the overtube 50 to the 1st balloon 30 vicinity, as shown in FIG.5 (f), air is supplied to the 2nd balloon 60, and it is made to expand. Thereby, the second balloon 60 is fixed to the intestinal tract 70. That is, the intestinal tract 70 is grasped by the second balloon 60.

  Next, as shown in FIG. 5 (g), the overtube 50 is pulled forward. As a result, the intestinal tract 70 contracts substantially straight, and the excess bending or bending of the overtube 50 is eliminated. It should be noted that when the overtube 50 is pulled together, both the first balloon 30 and the second balloon 60 are locked to the intestinal tract 70, but the frictional resistance of the first balloon 30 is higher than the frictional resistance of the second balloon 60. small. Therefore, even if the first balloon 30 and the second balloon 60 move relative to each other, the first balloon 30 having a small frictional resistance slides with respect to the intestinal tract 70, so that the intestinal tract 70 is connected to both the balloons 30, 60. Will not be damaged by being pulled by.

  Next, as shown in FIG. 5 (h), air is sucked from the first balloon 30 to contract the first balloon 30. And the front-end | tip part 36 of the insertion part 12 is inserted in the deep part of the intestinal tract 70 as much as possible. That is, the insertion operation shown in FIG. Thereby, the front-end | tip part 36 of the insertion part 12 can be inserted in the deep part of the intestinal tract 70. FIG. When inserting the insertion portion 12 into a deeper portion, after performing a fixing operation as shown in FIG. 5D, a pushing operation as shown in FIG. ), A hand dragging operation as shown in FIG. 5G, and an insertion operation as shown in FIG. Thereby, the insertion part 12 can be further inserted into the deep part of the intestinal tract 70.

  During such treatment, the endoscope apparatus according to the embodiment has the first air pressure resistance of the tube 110 and the air supply tube 29 for supplying air from the pump of the balloon control device 100 to the first balloon 30. Since it is set larger than the air pressure resistance of the balloon 30, there is no problem that the tube 110 and the air supply tube 29 are inflated without the first balloon 30 inflating. As a result, the pressure of the first balloon 30 is accurately detected by the pressure sensor of the balloon control device. Further, the tube 110 and the air supply tube 29 are not affected at all by the pressure fluctuation that occurs when the first balloon 30 is deflated by the pressure from the intestinal wall. Therefore, the pressure of the intestinal wall received by the first balloon 30 is accurately detected by the pressure sensor of the balloon control device.

  Similarly, the air pressure resistance of the tube 120 for supplying air from the pump of the balloon control device 100 to the second balloon 60 and the air supply tube 56 is set to be larger than the air pressure resistance of the second balloon 60. For this reason, the malfunction that the tube 120 and the air supply tube 56 do not inflate without the second balloon 60 inflating does not occur, whereby the pressure of the second balloon 60 is accurately detected by the pressure sensor of the balloon control device. . Further, the tube 120 and the air supply tube 56 are not affected at all by the pressure fluctuation generated when the second balloon 60 is deflated by the pressure from the intestinal wall. Therefore, the pressure of the intestinal wall received by the second balloon 60 is accurately detected by the pressure sensor of the balloon control device.

  In the embodiment, the air pressure resistance is set to be larger than the air pressure resistance of the first balloon 30 and the second balloon 60 depending on the material of the air supply conduit, but the thickness of the air supply conduit is increased. The net may be covered, or the net may be embedded to improve the air pressure resistance so as not to be affected by pressure fluctuations.

  Moreover, although the overtube 50 was illustrated as an insertion auxiliary tool in embodiment, it is not limited to this, The sliding tube inserted transanally can also be used.

System configuration diagram of an endoscope apparatus according to the present invention The perspective view which shows the front-end | tip part of the insertion part of an endoscope The perspective view which shows the front-end | tip part of the insertion part with which the 1st balloon was mounted | worn. Side sectional view showing the overtube Explanatory drawing which shows the operating method of the endoscope apparatus which concerns on this invention

Explanation of symbols

  DESCRIPTION OF SYMBOLS 10 ... Endoscope, 12 ... Insertion part, 14 ... Hand operation part, 26 ... Balloon air supply port, 28 ... Air supply suction port, 29 ... Air supply tube, 30 ... 1st balloon, 36 ... Tip part, 50 ... Over tube 51. Tube body 52. Grip portion 53 53 Liquid reservoir 54 Balloon air supply port 56 Air supply tube 60 Second balloon 100 100 Balloon controller 102 102 Device body 104 ... Hand switch, 110, 120 ... Tube

Claims (3)

A first balloon that can be expanded and contracted attached to the outer periphery of the distal end of the endoscope insertion portion, and a second balloon that can be expanded and contracted to the outer periphery of the distal end, and the endoscope insertion portion is inserted into the endoscope. An insertion assisting tool serving as a guide when inserting the insertion portion, a first air supply conduit connected at one end to the first balloon, a second air supply conduit connected at one end to the second balloon, and the first A balloon control device for controlling expansion and contraction of the first balloon and the second balloon by connecting the other ends of the first air supply duct and the second air supply duct and supplying and sucking air to and from the first balloon and the second balloon. In a double balloon type endoscope device comprising:
The first air supply conduit includes an air supply tube that is inserted through the endoscope insertion portion, and a connection tube that connects the air supply tube and the balloon control device,
The air supply tube inserted into the endoscope insertion portion has higher air pressure resistance than the air pressure resistance of the tube forming the connection tube and the second air supply conduit, and the first balloon and the first balloon 2. A double-balloon endoscope device characterized by low air pressure resistance of the balloon. The air supply tube inserted through the endoscope insertion portion is made of polytetrafluoroethylene, and the tube forming the connection tube and the second air supply conduit is made of silicon rubber. 2. The double balloon endoscope apparatus according to 1. The balloon control device includes a pump for supplying and sucking air to the first balloon and the second balloon, a switch for instructing air supply, suction and pressure holding to the first balloon and the second balloon, and the first balloon The double sensor according to claim 1, further comprising: a pressure sensor that detects pressures of the first balloon and the second balloon, wherein the pump is driven and controlled based on an operation of the switch and an output of the pressure sensor. Balloon endoscope device.

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