JP4412433B2 - Endoscope treatment device standing device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention is a so-called two-channel type endoscope that is used for medical purposes and has two built-in treatment tool insertion channels for inserting forceps and other treatment tools, and is inserted through one treatment tool insertion channel. The present invention relates to an endoscopic treatment tool erecting apparatus for erecting a treated treatment tool.
[0002]
[Prior art]
As shown in FIG. 6, the endoscope is generally provided with a main body operation unit 1 that is operated by a surgeon and is connected to the main body operation unit 1, and is inserted into a body cavity or the like. And the universal cord 3 that is pulled out from the main body operation unit 1 and detachably connected to the light source device or the like. The insertion portion 2 is a flexible portion 4 for most of the length from the connection portion to the main body operation portion 1, and an angle portion 5 and a hard tip portion 6 are sequentially connected to the flexible portion 4. The distal end hard portion 6 is provided with an illumination window and an observation window, and the angle portion 5 is bent up and down and left and right by remote operation from the main body operation portion 1 in order to point the distal end hard portion 6 in a desired direction. It can be operated.
[0003]
When performing endoscopy using the endoscope having the above-described configuration, for example, when a lesion is discovered, treatment such as extraction of the affected area, coagulation of the affected area, and tissue sampling may be performed. In order to be able to do so, a treatment instrument insertion channel for inserting forceps, a high-frequency treatment instrument and the like is provided. The treatment instrument insertion channel is connected to a treatment instrument lead-out section that opens at a position near the observation window at the distal end hard portion 6 of the insertion section 2. One treatment instrument insertion channel is generally provided. However, for example, when performing EMR (mucosal removal), in addition to the treatment tool for performing the treatment, an operation of lifting the affected part is required, so two treatment tools must be inserted. For this purpose, a so-called two-channel endoscope having two treatment instrument insertion channels is also used.
[0004]
7 to 9 show the configuration of the distal end portion of a conventional two-channel type endoscope. First, FIG. 7 shows a configuration of the distal end surface of the distal end hard portion 6 in the insertion portion 2. As is apparent from the figure, an observation window 10 is provided at the approximate center position on the distal end surface of the distal end hard portion 6, and illumination windows 11, 11 are provided at positions on both the left and right sides of the observation window 10. It has been. The treatment instrument deriving portions 12 and 13 provided at two locations are arranged at positions below the observation window 10 and divided into left and right. One treatment instrument deriving unit, that is, the first treatment instrument deriving unit 12 is configured to derive the treatment instrument straight. Further, the other treatment instrument deriving unit, that is, the second treatment instrument deriving unit 13 can stand the derived treatment instrument. For this purpose, the second treatment instrument outlet 13 is provided with a treatment instrument erecting device.
[0005]
FIG. 8 shows the configuration of the treatment instrument standing device. In the figure, reference numeral 20 denotes a distal end portion main body constituting the distal end rigid portion 6, and two treatment instrument insertion channels 14 and 15 are connected to the distal end portion main body 20 as shown in FIG. . Here, the treatment instrument insertion channels 14 and 15 have different diameters, and the large-diameter treatment instrument insertion channel 14 is connected to the first treatment instrument lead-out section 12 that does not have a treatment instrument erecting function, so that the treatment with a small diameter is performed. The instrument insertion channel 15 is connected to a second treatment instrument lead-out portion 13 having a treatment instrument standing function.
[0006]
The second treatment instrument derivation unit 13 is configured to open largely to the distal end body 20, and a treatment instrument stand 21 is attached to the second treatment instrument derivation unit 13. As is apparent from FIG. 7, the treatment instrument stand 21 has a standing surface 21 a, and this standing surface 21 a is disposed at a substantially extended line position of the treatment instrument insertion channel 15. A rotating shaft 22 is connected to the treatment instrument stand 21, and the treatment instrument stand 21 stands up obliquely upward, that is, in a direction close to the observation window 10, with the rotation shaft 22 as a center. It is supposed to let you. The operation of rotating the treatment instrument stand 21 about the rotation axis 22 is performed by remote operation from the main body operation unit 1. For this purpose, the main body operation unit 1 is provided with an upright lever 7. ing. The standing lever 7 is for pushing and pulling the operation wire 23.
[0007]
Since the insertion portion 2 is a flexible member in the bending direction except for the distal end hard portion 6, the operation wire 23 for operating the treatment instrument stand 21 by remote operation is In a state of being inserted into the flexible tube 24, it is guided to a position in the vicinity of the tip body 20. A guide pipe 25 is fixedly provided on the distal end body 20, and the flexible tube 24 is connected to the guide pipe 25. The operation wire 23 is further inserted into the guide pipe 25, and a spherical portion 23 a provided at the tip thereof is fixed to the side surface of the treatment instrument stand 21. Therefore, the control cable 26 is configured by inserting the operation wire 23 into the flexible tube 24.
[0008]
By configuring as described above, when the treatment instrument is inserted from the treatment instrument insertion channel 15 to the second treatment instrument lead-out portion 13, the treatment instrument is guided onto the standing surface 21a of the treatment instrument stand 21, and this It protrudes forward from the standing surface 21a. Therefore, when the standing lever 7 is operated and the operation wire 23 is pulled, the treatment instrument stand 21 rotates around the rotation shaft 22 and is directed substantially in the axial direction of the insertion portion 2. Since the standing surface 21a is inclined upward, the treatment tool can be raised. Moreover, the standing angle of the treatment instrument also changes according to the amount of operation of the standing lever 7.
[0009]
[Problems to be solved by the invention]
As is clear from FIG. 7, the first and second treatment instrument derivation units 12 and 13 are arranged to be arranged below the observation window 10. The treatment instrument insertion channels 14 and 15 connected to the first and second treatment instrument derivation sections 12 and 13 maintain substantially the same positional relationship as the first and second treatment instrument derivation sections 12 and 13. It is extended to the main body operation unit 1 side. Further, the connection portion of the operation wire 23 to the treatment instrument stand 21 is substantially the position between the treatment instrument insertion channels 13 and 14, and therefore, the flexibility through which the operation wire 23 and the operation wire 23 are inserted. A control cable 26 composed of a tube 24 extends between the treatment instrument insertion channels 13 and 14 toward the main body operation unit 1 side.
[0010]
From the above, the cross-section in the vicinity of the connecting portion to the distal end hard portion 6 of the angle portion 5 inside the insertion portion 2 has the structure shown in FIG. In the figure, 16 is a cable from a solid-state imaging device constituting observation means mounted on the observation window, 17 and 17 are light guides for transmitting illumination light to the illumination window 11, and 18 is washed toward the observation window 10. It is an air / water supply tube connected to a nozzle for injecting a working fluid and supplying cleaning water and pressurized air as a cleaning fluid. Further, 19U, 19D, 19R, and 19L are angle operation wires. When the angle portion 5 is bent upward, the angle operation wire 19U is bent. When the angle portion 5 is bent downward, the angle operation wire 19C is turned rightward. A pulling force is applied to the angle operation wire 19R when bending, and a further leftward bending when operating the angle operation wire 19L.
[0011]
Therefore, in the insertion portion 2, the cable 16, the light guide 17, and the air / water supply tube 18 are arranged in the upper region with the line H connecting the angle operation wires 19R and 19L as a boundary, and the treatment instrument is inserted. The channels 14 and 15 and the control cable 26 are located in the lower region. Moreover, the treatment instrument insertion channels 14 and 15 have the largest cross-sectional area among the members. Thus, since the filling rate on the lower side of the insertion portion 2 is extremely high, the thickness of the insertion portion 2 greatly depends on the filling rate of the lower region. Here, when the insertion portion 2 is inserted into the body cavity, there is an extremely high demand for reducing the diameter of the insertion portion 2 from the viewpoint of reducing the pain of the patient and the insertion operability of the insertion portion 2. However, the insertion portion 2 has a problem in that the diameter cannot be reduced because the filling rate in the lower region is high.
[0012]
As is clear from FIG. 8, the operation wire 23 is slightly bowed when inserted into the guide pipe 25. However, the extending direction of the operation wire 23 is that the treatment tool of the spherical portion 23a is raised at the tip. Since the connecting position to the table 21 is substantially in the direction of the extension line, the standing operation of the treatment instrument stand 21 requires a very large force. Therefore, extending the operation wire 23 in this direction is not always advantageous for the treatment instrument standing operation.
[0013]
The present invention has been made in view of the above points, and an object of the present invention is to reduce the diameter of the insertion portion and to improve the erection operability of the treatment instrument.
[0014]
[Means for Solving the Problems]
In order to achieve the above-described object, the present invention provides an observation window disposed at a substantially central position on the distal end surface of the distal end main body of the insertion portion connected to the main body operation portion of the endoscope, and the vicinity of the observation window. A first treatment instrument lead-out portion that is disposed at the left and right positions on the lower side of the observation window and does not have a treatment instrument standing member; and a second that includes a treatment instrument standing member. And a treatment wire extending from an insertion portion to a main body operation portion for remotely operating the treatment tool erecting member by remote operation. A guide pipe having a fixed portion and a flexible tube connected to the base end portion is fixed to the distal end body, and the operation wire is inserted from the guide pipe into the flexible tube; and The guide pipe is provided with the treatment instrument The operating wire connected to a member, it is an its features that it has a configuration to extend obliquely upward to guide an upper position than the rear portion of the observation window.
[0015]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, an embodiment of the present invention will be described in detail with reference to FIGS. 1 to 3. In addition, about the component same or equivalent to the prior art mentioned above, the same code | symbol as used by the prior art is used, and description about them shall be abbreviate | omitted.
[0016]
Thus, the configuration of the distal end surface of the distal end hard portion 6 of the insertion portion 2 is substantially the same as that shown in FIG. As is clear from FIGS. 1 and 2, the treatment instrument stand 21 provided in the second treatment instrument lead-out portion 13 is rotatably connected to the distal end body 20 by a rotation shaft 22. The rotation direction is a direction approaching / separating from the observation window 10. The standing surface 21 a of the treatment instrument stand 21 is normally held in a straight state toward the axial direction of the insertion portion 2. A spherical portion 23 a provided at the distal end of the operation wire 23 is connected and fixed to the side surface portion of the treatment instrument stand 21, and the operation lever 23 is operated to pull the operation wire 23. As a result, the treatment instrument stand 21 stands up, and the standing surface 21a faces obliquely upward. Here, the connection part of the operation wire 23 to the treatment instrument stand 21 is a position between the first and second treatment instrument lead-out parts 12 and 13.
[0017]
With respect to the above points, there is no particular difference from the configuration of the prior art described above. The observation window 10 is provided with an objective optical system 30. The objective optical system 30 includes an objective lens 30a and a prism 30b for bending the optical path of the objective lens 30a by 90 °, and the prism 30b. Is attached with a solid-state image pickup device 31. Accordingly, the solid-state imaging device 31 extends in the axial direction of the insertion portion 2 and is disposed at an upper position of the longitudinal section of the insertion portion 2, that is, at a position opposite to the treatment instrument insertion channels 14 and 15. Yes. Further, a sealing material 32 is filled in a portion from the rear portion of the prism 30b to the solid-state imaging device 31.
[0018]
The distal end body 20 is provided with a guide pipe 33 fixed at a position directly below the objective lens 30 a, and the distal end of a flexible tube 34 is connected to the guide pipe 33. The operation wire 23 provided for raising the treatment instrument stand 21 by remote operation is extended from the connecting portion to the treatment instrument stand 21 and inserted into the guide pipe 33 and the flexible tube 34. The main body operation unit 1 is extended. The flexible tube 34 is provided with a close-contact coil on its inner peripheral portion in order to improve compression resistance.
[0019]
Here, the guide pipe 33 is provided with its distal end fixed to an attachment portion 20 a provided in the distal end portion main body 20, and is directed obliquely upward through the inside of the sealing material 32. Accordingly, the guide pipe 33 has a straight pipe portion 33a extending in a direction substantially parallel to the optical path of the objective lens 30a at a position close to the objective lens 30a, and the proximal end side of the straight pipe portion 33a. Is a curved pipe portion 33b bent toward the upper direction. The curved pipe portion 33 b and the flexible tube 34 are connected via a connection pipe 35. The flexible tube 34 extends further obliquely upward to a predetermined position and is directed in the axial direction of the insertion portion 2.
[0020]
Thus, the prism 30 b is disposed at the rear of the objective lens 30 a constituting the objective optical system 30, and the solid-state image pickup device 31 faces the axial direction of the insertion portion 2, and the cable 16 is connected to the solid-state image pickup device 31. It is connected. For this reason, some space is generated on the back surface of the prism 30b. The curved pipe part 33b of the guide pipe 33 and the connection part to the flexible tube 34 in the curved pipe part 33b are arranged in this space. Moreover, in the angle portion 5 of the insertion portion 2, flexible members such as the cable 16 and the light guide 17 are inserted on the upper side of the line H connecting the angle operation wires 19R and 19L, and other insertion members are used. Since the air / water supply tube 18 is thin, there is a space on the upper side, and there is a degree of freedom in arrangement. On the other hand, the treatment instrument insertion channels 14 and 15 not only have a large diameter but also cannot be bent extremely in the insertion portion 2 because of the relation of inserting a treatment instrument such as a forceps therein, and each of the treatment instrument insertion channels 14 and 15 is approximately first. The second treatment instrument lead-out portions 12 and 13 must be arranged at the extended line position. Therefore, by extending the operation wire 23 inserted through the flexible sleeve 24 to the upper side as shown in FIGS. 3 and 4, the filling rate on the lower side can be reduced and the filling can be reduced. It can be smoothly pulled out to the upper side where the rate is low. As a result, space saving in the insertion portion 2 is achieved, and the diameter can be reduced.
[0021]
In a state where the treatment tool F is projected from the distal end of the insertion portion 2 through the treatment tool insertion channel 15 through the second treatment tool lead-out portion 13, no pulling force acts on the operation wire 23. As shown, the derivation direction of the treatment instrument F is almost straight. When the standing lever 7 is operated from this state and the operating wire 23 is pulled, the treatment instrument stand 21 rotates upwardly about the rotation shaft 21. As a result, the treatment instrument F is indicated by a solid line in FIG. Will stand up. If the pulling force on the operation wire 23 is adjusted, the treatment instrument F is displaced between the phantom line and the solid line, so that it is possible to perform operations such as grasping the affected area and lifting it to a predetermined height, for example. Become. Here, the operation wire 23 extends obliquely upward from the connection portion to the treatment instrument stand 21 and extends substantially to the upper end. Accordingly, during the standing operation of the treatment instrument stand 21, the operation wire 23 can be smoothly lifted up with a light load since it is pulled up obliquely upward.
[0022]
【The invention's effect】
According to the present invention, in a two-channel type endoscope, a guide pipe through which an operation wire is inserted is provided in a treatment instrument lead-out portion provided with a treatment instrument standing member, and the guide pipe is positioned above the rear portion of the observation window. By extending obliquely upward, the insertion portion can be reduced in diameter, and effects such as improvement in the erection operability of the treatment instrument can be achieved.
[Brief description of the drawings]
FIG. 1 is a front view of a distal end portion of an insertion portion of an endoscope showing an embodiment of the present invention.
FIG. 2 is a cross-sectional view taken along the line AA of FIG.
3 is a cross-sectional view taken along the line BB in FIG.
4 is a cross-sectional view taken along the line CC of FIG.
FIG. 5 is an operation explanatory view of the treatment instrument stand.
FIG. 6 is an overall configuration diagram of an endoscope.
FIG. 7 is a front view of an insertion portion in an endoscope according to a conventional technique.
8 is a cross-sectional view taken along the line DD of FIG.
9 is a cross-sectional view taken along the line EE of FIG.
10 is a cross-sectional view taken along line FF in FIG.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Main body operation part 2 Insertion part 4 Soft part 5 Angle part 6 Tip hard part 7 Standing lever 10 Observation window 12 1st treatment instrument derivation | leading-out part 13 2nd treatment instrument derivation | leading-out parts 14, 15 Treatment instrument insertion channel 20 Tip part main body 21 treatment instrument stand 22 rotating shaft 23 operation wire 24 flexible tube 33 guide pipe 35 connecting pipe

Claims (1)

An observation window disposed at a substantially central position on the distal end surface of the distal end main body of the insertion portion provided continuously with the main body operation unit of the endoscope, at least one illumination window disposed in the vicinity of the observation window, and the observation A first treatment instrument derivation unit that is disposed at the left and right positions on the lower side of the window and does not have a treatment instrument erection member, and a second treatment instrument derivation unit that includes a treatment instrument erection member are provided. In a configuration in which an operation wire for standing operation by remote operation is extended from the insertion portion to the main body operation portion,
A rigid guide pipe having a distal end portion fixed to the distal end portion main body and a flexible tube connected to a proximal end portion is fixed to the distal end portion main body, and the operation wire is inserted into the flexible tube from the guide pipe. Without letting go through,
The guide pipe extends in an obliquely upward direction so that the operation wire connected to the treatment instrument erecting member is guided to an upper position from a rear portion of the observation window. Mirror treatment tool standing device.

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