JP4768365B2 - Insertion aid for endoscope and endoscope apparatus - Google Patents

Description

  The present invention relates to an endoscope insertion aid and an endoscope device, and more particularly to an endoscope device in which an inflatable balloon is fixed to an insertion portion of an endoscope with a band and inserted into and removed from the insertion aid.

  When inserting the insertion part of the endoscope into the deep digestive tract such as the small intestine, simply pushing 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. For example, if excessive bending or bending occurs in the insertion portion, the insertion portion cannot be inserted further deeper. Therefore, a method has been proposed in which an insertion aid is put on the insertion portion of the endoscope and inserted into the body cavity, and the insertion portion is guided by this insertion aid to prevent excessive bending or bending of the insertion portion. Yes.

  For example, Patent Document 1 discloses an endoscope apparatus in which a first balloon is provided at a distal end portion of an insertion portion of an endoscope and a second balloon is provided at a distal end portion of an insertion assisting tool (also referred to as an overtube or a sliding tube). Is described. By inflating the first balloon and the second balloon, the insertion portion and the insertion aid can be fixed in the intestinal tract such as the small intestine. Accordingly, by alternately inserting the insertion portion and the insertion assisting tool while repeatedly expanding and contracting the first balloon and the second balloon, the insertion portion can be inserted into a deep portion of the intestinal tract that is bent in a complicated manner, such as the small intestine. .

  By the way, when a lesion is incised by endoscopic submucosal dissection (ESD) in the deep digestive tract such as the small intestine, an endoscopic forceps is used to remove the lesion after the incision outside the body cavity. A treatment instrument such as a grasping forceps or a collection net is inserted into the channel. If the lesion is larger than the forceps channel, the lesion cannot be pulled into the forceps channel, so the body cavity is pulled out from the insertion aid together with the insertion portion of the endoscope while holding the lesion with the treatment instrument. I'm taking it out.

However, the distal end of the insertion assisting tool is usually a gap between the insertion assisting tool and the insertion part in order to prevent the intestinal tract from being caught in the gap between the insertion assistance tool and the insertion part or to prevent leakage of body fluid. Is very small (see, for example, Patent Document 2).
JP 2002-301019 A JP 2001-340462 A

  For this reason, in the conventional endoscope apparatus, when the insertion portion of the endoscope is pulled out from the insertion assisting tool, there is a possibility that the balloon attached to the insertion portion is caught on the distal end of the insertion assisting tool. In particular, when the balloon is fixed to the insertion portion with a band, since the band protrudes from the outer peripheral surface of the insertion portion, the band may be caught on the tip of the insertion assisting tool and the balloon may be turned over.

  The present invention has been made in view of such circumstances, and provides an insertion assisting tool for an endoscope and an endoscope apparatus capable of reliably inserting and removing the insertion portion of the endoscope into and from the insertion assisting tool. With the goal.

In order to achieve the above object, the invention according to claim 1 is for an endoscope which is formed in a cylindrical shape and assists the insertion of the insertion portion into the body cavity by inserting the insertion portion of the endoscope. In the insertion assisting tool, a guide hole formed in the circumferential direction at the distal end portion of the insertion assisting tool, and inserted through the guide hole, and at least one end portion extends to the base end of the insertion assisting tool. A linear member, and by narrowing the linear member in the guide hole by pulling one end of the linear member, the distal end of the insertion assisting tool is reduced in diameter, and the linear member is An expansion / contraction means for expanding the diameter of the distal end portion of the insertion assisting tool by loosening is provided.

  According to the first aspect of the present invention, since the expansion / contraction means for expanding or reducing the diameter of at least a part of the inner peripheral surface is provided, for example, during the insertion operation, the gap between the insertion assisting tool and the insertion portion is reduced to reduce the intestinal tract. Can be prevented, leakage of bodily fluids, and the like. On the other hand, when collecting foreign matter, the gap between the insertion assisting tool and the insertion portion can be increased so that the insertion portion can be reliably inserted into and removed from the insertion assisting tool. Therefore, even when a balloon is attached to the insertion portion and fixed with a band, or when a hood is attached to the tip of the insertion portion, the insertion portion can be reliably inserted into and removed from the insertion aid. There is no fear of turning over.

According to a second aspect of the present invention, in the first aspect of the present invention, the locking means for locking the end of the linear member is provided on the proximal end side of the insertion assisting tool.

According to a third aspect of the present invention, in the first aspect of the present invention, both ends of the linear member are pulled out from the proximal end of the insertion assisting tool, and the both ends are simultaneously pulled. It is characterized by.

According to a fourth aspect of the present invention, in the first aspect of the invention, the linear member has one end fixed to a sleeve inserted through the linear member provided on the distal end side of the insertion assisting tool. The other end of the linear member is pulled out from the proximal end of the insertion assisting tool and is pulled.

In order to achieve the above-mentioned object, the invention according to claim 5 is formed in a cylindrical shape with an endoscope in which an inflatable and inflatable balloon is attached to the insertion portion, and the balloon is fixed by a ring-shaped band. Insertion assistance provided with expansion / contraction means for expanding the diameter of the distal end portion of the insertion assisting tool according to any one of claims 1 to 4 , while assisting insertion of the insertion portion into a body cavity by inserting the insertion portion. comprising a tool, and by the state of enlarged diameter of the inner peripheral surface of the distal end portion of the insertion aid with the scaling means, the insertion portion to which the balloon is attached that is inserted through the insertion auxiliary member It is characterized by.

  According to the fifth aspect of the present invention, since the distal end portion of the insertion assisting tool is configured to be expandable / contractable, the insertion part in which the balloon is fixed by the band can be reliably inserted into and removed from the insertion assisting tool.

  According to the present invention, since the inner peripheral surface of the insertion assisting tool can be expanded and contracted, the insertion portion of the endoscope can be reliably inserted into and removed from the insertion assisting tool.

  DESCRIPTION OF EMBODIMENTS Preferred embodiments of an endoscope insertion aid and an endoscope apparatus according to the present invention will be described below in detail with reference to the accompanying drawings.

  FIG. 1 is a system configuration diagram showing an endoscope apparatus to which the present invention is applied. As shown in FIG. 1, the endoscope apparatus mainly includes an endoscope 10, an insertion assisting tool 70, and a balloon control device 100.

  The endoscope 10 includes a hand operation unit 14 and an insertion unit 12 that is connected to the hand operation unit 14 and is inserted into a body cavity. A universal cable 16 is connected to the hand operation unit 14, and an LG connector 18 is provided at the tip of the universal cable 16. The LG connector 18 is detachably connected to the light source device 20, thereby sending illumination light to an illumination optical system 54 (see FIG. 2) described later. In addition, an electrical connector 24 is connected to the LG connector 18 via a cable 22, and the electrical connector 24 is detachably coupled to the processor 26.

  The hand operating unit 14 is provided with an air / water supply button 28, a suction button 30, a shutter button 32, and a function switching button 34, and a pair of angle knobs 36 and 36. A balloon air supply port 38 is formed at the proximal end portion of the hand operation unit 14 by a tube bent in an L shape. By supplying or sucking fluid such as air to the balloon air supply port 38, the first balloon 60 described later can be inflated or deflated.

  The insertion portion 12 is composed of a flexible portion 40, a bending portion 42, and a distal end portion 44 in order from the hand operation portion 14 side. The bending portion 42 is remotely controlled by rotating the angle knobs 36, 36 of the hand operation portion 14. Bending operation. Thereby, the front-end | tip part 44 can be turned to a desired direction.

  As shown in FIG. 2, an observation optical system 52, illumination optical systems 54 and 54, an air / water supply nozzle 56, and a forceps port (corresponding to an opening for suction) 58 are provided on the distal end surface 45 of the distal end portion 44. It is done.

  A CCD (not shown) is disposed behind the observation optical system 52, and a signal cable (not shown) is connected to a substrate that supports the CCD. The signal cable is inserted into the insertion portion 12, the hand operating portion 14, the universal cable 16, and the like of FIG. Therefore, the observation image captured by the observation optical system 52 is formed on the light receiving surface of the CCD and converted into an electric signal, and this electric signal is output to the processor 26 via the signal cable and converted into a video signal. Is done. Thereby, an observation image is displayed on the monitor 50 connected to the processor 26.

  An exit end of a light guide (not shown) is disposed behind the illumination optical systems 54 and 54 in FIG. The light guide is inserted through the insertion portion 12, the hand operating portion 14, and the universal cable 16 of FIG. 1, and an incident end is disposed in the LG connector 18. Therefore, by connecting the LG connector 18 to the light source device 20, the illumination light emitted from the light source device 20 is transmitted to the illumination optical systems 54 and 54 via the light guide, and irradiated forward from the illumination optical systems 54 and 54. Is done.

  The air / water supply nozzle 56 in FIG. 2 is connected to a valve (not shown) operated by the air / water supply button 28 in FIG. 1, and this valve is also connected to the air / water supply connector provided in the LG connector 18. 48 is communicated. An air / water supply means (not shown) is connected to the air / water supply connector 48 to supply air or water. Therefore, by operating the air / water supply button 28, air or water can be ejected from the air / water supply nozzle 56 toward the observation optical system 52.

  The forceps port 58 in FIG. 2 communicates with the forceps insertion portion 46 in FIG. Therefore, by inserting a treatment tool such as a forceps from the forceps insertion portion 46, the treatment tool can be led out from the forceps port 58. The forceps port 58 communicates with a valve (not shown) operated by the suction button 30, and this valve is further connected to the suction connector 49 of the LG connector 18. A suction pump 51 is connected to the suction connector 49. Therefore, by operating the suction pump 51 and operating the valve with the suction button 30, body fluid, air, or the like can be sucked from the forceps port 58.

  As shown in FIG. 2, a first balloon 60 made of an elastic body such as rubber is attached to the outer peripheral surface of the insertion portion 12. The first balloon 60 is formed in a substantially cylindrical shape with both ends narrowed. After the insertion portion 12 is inserted and the first balloon 60 is disposed at a desired position, the first balloon 60 is disposed as shown in FIG. The first balloon 60 is fixed to the insertion portion 12 by fitting rubber fixing rings (corresponding to bands) 62 and 62 into both ends of the 60. As shown in FIGS. 4A and 4B, each fixing ring 62 is preferably formed with a taper 62A such that the rear end side gradually decreases. Thereby, it is possible to more reliably prevent the fixing ring 62 from being caught by the distal end of the insertion assisting tool 70 in the later-described insertion / extraction operation.

  A vent hole 64 is formed on the outer peripheral surface of the insertion portion 12 where the first balloon 60 is attached. The ventilation hole 64 communicates with a balloon air supply port 38 provided in the hand operation unit 14 of FIG. The balloon air supply port 38 is connected to the balloon control device 100 via the tube 110. Therefore, the first balloon 60 can be inflated and deflated by supplying and sucking air by the balloon control device 100. The first balloon 60 is inflated into a substantially spherical shape by supplying air, and sticks to the outer surface of the insertion portion 12 by sucking air.

  On the other hand, the insertion assisting tool 70 shown in FIG. 1 is composed of a cylindrical and rigid gripping portion 72 provided on the proximal end side, and a main body tube 73 attached to the distal end of the gripping portion 72. The insertion portion 12 of the endoscope 10 is inserted into the main body tube 73 from the gripping portion 72 side.

  The main body tube 73 has a flexible resin tube made of urethane or the like as a base material, and an outer peripheral surface and an inner peripheral surface of the base material are coated with a hydrophilic coating material (lubricating coating material). As the hydrophilic coating material, for example, polyvinylpyrrolidone, acrylic resin, or silicon resin is used.

  A second balloon 80 is attached in the vicinity of the distal end of the main body tube 73. The second balloon 80 is formed in a cylindrical shape whose both ends are narrowed. The second balloon 80 is mounted in a state where the insertion assisting tool 70 is penetrated, and is fixed by winding a thread (not shown). A tube 74 attached to the outer peripheral surface of the insertion assisting tool 70 is communicated with the second balloon 80, and a connector 76 is provided at the proximal end portion of the tube 74. A tube 120 is connected to the connector 76, and is connected to the balloon control device 100 via the tube 120. Therefore, the second balloon 80 can be inflated and deflated by supplying and sucking air with the balloon control device 100. The second balloon 80 is expanded into a substantially spherical shape by supplying air, and is attached to the outer peripheral surface of the insertion assisting tool 70 by sucking air.

  An injection port 78 is provided on the proximal end side of the insertion assisting tool 70. The injection port 78 communicates with an opening (not shown) formed on the inner peripheral surface of the insertion assisting tool 70. Therefore, the lubricant can be supplied into the insertion aid 70 by injecting the lubricant (for example, water) from the injection port 78 with a syringe or the like. Therefore, when the insertion portion 12 is inserted into the insertion assisting tool 70, the friction between the inner peripheral surface of the insertion assisting tool 70 and the outer peripheral surface of the insertion portion 12 can be reduced, and the relative relationship between the insertion portion 12 and the insertion assisting tool 70 can be reduced. Movement can be performed smoothly.

  As shown in FIG. 3, a cap 83, a shape memory member 84, and a heater 85 are attached to the distal end portion 73 </ b> A of the main body tube 73 at the distal end portion of the insertion assisting tool 70. The distal end of the main body tube 73 is formed with the same inner diameter as the other part and an outer diameter smaller than the other part. Accordingly, the distal end portion 73A of the main body tube 73 is formed thinner than other portions and is easily deformed.

  The heater 85 is formed in a ring shape, and is attached in a state of being fitted on the distal end portion 73 </ b> A of the main body tube 73. A lead wire 86 is connected to the heater 85, and the lead wire 86 is inserted into the hole 87 of the main body tube 73. The hole 87 is formed along the axial direction of the main body tube 73 and extends to the base end portion. The lead wire 86 inserted through the hole 87 is pulled out from the proximal end portion of the insertion assisting tool 70 and connected to a power supply source (not shown). Therefore, the heater 85 can be heated by energizing the heater 85.

  The shape memory member 84 is formed in a substantially ring shape in which a plate material is wound in a ring shape one or more times and a part thereof is overlapped. The shape memory member 84 is fitted on the distal end portion 73 </ b> A of the main body tube 73 and is attached to a position adjacent to the heater 85. Further, the shape memory member 84 is made of a shape memory material (shape memory alloy, shape memory resin or the like), and when heated to a predetermined temperature or higher, the diameter is expanded as shown in FIG. When it is deformed to the state and cooled on the contrary, it is deformed to a reduced diameter state as shown in FIG. 4A, the diameter d1 of the distal end of the insertion assisting tool 70 is substantially the same as the diameter d2 of the other part and is larger than the outer diameter d3 of the fixing ring 62. ing. Therefore, when the insertion portion 12 is inserted into and removed from the insertion assisting tool 70, the fixing ring 62 is not caught by the insertion assisting tool 70 and can be smoothly inserted and removed. On the other hand, in the reduced diameter state shown in FIG. 4B, the diameter d1 of the distal end of the insertion assisting tool 70 is smaller than the diameter d2 of the other portion and slightly larger than the outer diameter d4 of the insertion portion 12. Yes. Therefore, since the clearance between the insertion assisting tool 70 and the insertion portion 12 is small at the distal end portion of the insertion assisting tool 70, when the insertion portion 12 is pushed and pulled, the intestinal tract or the like (the digestive tract 90 in FIG. 5) enters the clearance. Can be prevented. Moreover, since the said clearance gap is small, it can suppress that a bodily fluid leaks out of a body cavity, or the lubricant inject | poured into the said clearance gap leaks out into a body.

  The cap 83 is formed in a cylindrical shape, and is fitted on and fixed to the base end portion 73 </ b> A of the main body tube 73. By attaching the cap 73, the heater 85 and the shape memory member 84 are prevented from being exposed to the outside. The cap 83 is formed of the same material as the main body tube 73 or a softer material than the main body tube 73, and is configured not to prevent the distal end portion 73A of the main body tube 73 from being deformed.

  As shown in FIG. 1, the balloon control device 100 is a device that supplies and sucks fluid such as air to the first balloon 60 and supplies and sucks fluid such as air to the second balloon 80. The balloon control device 100 mainly includes a device main body 102 and a hand switch 104 for remote control.

  On the front surface of the apparatus main body 102, a power switch SW1, a stop switch SW2, a first pressure display unit 106, a second pressure display unit 108, a first function stop switch SW3, and a second function stop switch SW4 are provided. The first pressure display unit 106 and the second pressure display unit 108 are panels for displaying the pressure values of the first balloon 60 and the second balloon 80, respectively. When an abnormality such as balloon breakage occurs, the pressure display units 106 and 108 are displayed. An error code is displayed.

  The first function stop switch SW3 and the second function stop switch SW4 are switches for turning on / off the functions of an endoscope control system A and an insertion assisting tool control system B, which will be described later. When only one of the two balloons 80 is used, the function stop switches SW3 and SW4 which are not used are operated to turn off the function. In the control system A or B in which the function is turned off, air supply and suction are completely stopped, and the pressure display unit 106 or 108 of the system is also turned off. The function stop switches SW3 and SW4 can be set to an initial state by turning off both of them. For example, the calibration with respect to the atmospheric pressure is performed by turning off both function stop switches SW3 and SW4 and simultaneously pressing all the switches SW5 to SW9 of the hand switch 104.

  A tube 110 that supplies and sucks air to the first balloon 60 and a tube 120 that supplies and sucks air to the second balloon 80 are connected to the front surface of the apparatus main body 102. The connection portions between the tubes 110 and 120 and the apparatus main body 102 are provided with backflow prevention units 112 and 122 for preventing backflow of body fluid when the first balloon 60 or the second balloon 80 is torn. The backflow prevention units 112 and 122 are configured by incorporating a gas-liquid separation filter in a hollow disk-like case (not shown) that is detachably attached to the apparatus main body 102. The filter prevents the liquid from flowing in.

  In addition, the pressure display units 106 and 108, the function stop switches SW3 and SW4, and the backflow prevention units 112 and 122 are always arranged in a constant manner for the endoscope 10 and the insertion assisting tool 70. That is, the pressure display unit 106, the function stop switch SW3, and the backflow prevention unit 112 for the endoscope 10 are respectively connected to the pressure display unit 108, the function stop switch SW4, and the backflow prevention unit 122 for the insertion assisting tool 70. Located on the right side.

  On the other hand, the hand switch 104 includes a stop switch SW5 similar to the stop switch SW2 on the apparatus main body 102 side, an ON / OFF switch SW6 for instructing pressurization / decompression of the first balloon 60, and the pressure of the first balloon 60. A pause switch SW7 for holding, an ON / OFF switch SW8 for instructing pressurization / depressurization of the second balloon 80, and a pause switch SW9 for holding the pressure of the second balloon 80 are provided. The hand switch 104 is electrically connected to the apparatus main body 102 via the cord 130. Although not shown in FIG. 1, the hand switch 104 is provided with a display unit that indicates an air supply state or an exhaust state of the first balloon 60 or the second balloon 80.

  The balloon control device 100 configured as described above supplies air to the balloons 60 and 80 to inflate them and controls the air pressure to a constant value to hold the balloons 60 and 80 in an inflated state. In addition, air is sucked from each balloon 60 and 80 and contracted, and the air pressure is controlled to a constant value to hold each balloon 60 and 80 in a contracted state.

  The balloon control device 100 is connected to the balloon dedicated monitor 82 and displays the pressure value and the inflated / deflated state of the balloons 60 and 80 on the balloon dedicated monitor 82 when the balloons 60 and 80 are inflated and deflated. . The pressure values and the inflated / deflated states of the balloons 60 and 80 may be superimposed on the observation image of the endoscope 10 and displayed on the monitor 50.

  Next, a method of inserting the insertion portion 12 into the body cavity in the endoscope apparatus configured as described above will be described with reference to FIGS. In addition, although Fig.5 (a)-(j) is an example which inserts orally, you may make it insert through a gait.

  First, with the first balloon 60 and the second balloon 80 being deflated, the insertion portion 12 is inserted through the insertion assisting tool 70, and then insertion of the insertion portion 12 is started. Then, as shown in FIG. 5A, the insertion section 12 is inserted until the distal end of the insertion section 12 reaches the inside of the stomach 90A. Next, the insertion assisting tool 70 is inserted along the insertion portion 12, and the distal end of the insertion assisting tool 70 reaches the stomach 90A as shown in FIG. 5 (b).

  Next, in a state where the insertion assisting tool 70 is grasped so as not to come out of the body cavity, the insertion portion 12 is pushed into the insertion assisting tool 70, and as shown in FIG. Insert until the duodenum limb 90B is reached (insertion operation). Then, the first balloon 60 is inflated to fix the distal end of the insertion portion 12 to the duodenum limb (fixing operation).

  Next, by inserting the insertion assisting tool 70, the insertion assisting tool 70 is inserted along the insertion portion 12 (pressing operation). Then, as shown in FIG. 5 (d), after the distal end portion of the insertion assisting tool 70 is brought near the first balloon 60, air is supplied to the second balloon 80 and inflated. As a result, the second balloon 80 is fixed to the descending leg 90B of the duodenum, and the descending leg 90B of the duodenum is held by the insertion assisting tool 70 via the second balloon 80 (holding operation).

  In this state, the insertion assisting tool 70 and the insertion portion 12 are brought together (hand feeding operation). Thereby, the excessive bending and bending of the digestive tract 90 to the descending limb 90B of the duodenum are removed.

  Next, after sucking air from the first balloon 60 to contract the first balloon 60, the insertion section 12 is advanced to the inside of the small intestine 90C as shown in FIG. 5 (e) (insertion operation). At this time, the extra bending of the digestive tract 90 up to the descending leg 90B of the duodenum is removed by the insertion assisting tool 70, so that the insertion portion 12 can be easily inserted.

  Next, as shown in FIG. 5 (f), the first balloon 60 is inflated to fix the distal end of the insertion portion 12 to the digestive tract 90. After the second balloon 80 is deflated, as shown in FIG. 5G, the insertion assisting tool 70 is inserted along the insertion portion 12, and the distal end of the insertion assisting tool 70 is in the vicinity of the first balloon 60. The second balloon 80 is inflated in the state of being in close proximity to.

  Next, as shown in FIG. 5 (h), the insertion assisting tool 70 and the insertion portion 12 are pulled together while the first balloon 60 and the second balloon 80 are inflated. Thereby, the excessive bending and bending of the digestive tract 90 are removed.

  By repeating the above-described operation, the digestive tract 90 that has been bent or bent in a complicated manner is simplified as shown in FIG. Therefore, as shown in FIG. 5 (j), the insertion portion 12 can be inserted further into the digestive tract 90.

  Next, a method for collecting a large foreign object using the endoscope apparatus of the present embodiment will be described. The large foreign matter is larger than the forceps opening 58 (for example, a lesion part incised by ESD or a medical capsule such as a capsule endoscope), and such foreign matter is drawn into the forceps opening 58. I can't. Therefore, it is necessary to grip a foreign object in front of the insertion portion 12 and pull it out of the insertion assisting tool 70 together with the insertion portion 12.

  Before the foreign substance collecting operation, the distal end of the insertion assisting tool 70 is in a reduced diameter state as shown in FIG. That is, the gap between the inner peripheral surface and the outer peripheral surface of the insertion assisting tool 70 is small at the tip of the insertion assisting tool 70. Therefore, for example, when the insertion portion 12 is inserted into the deep digestive tract as shown in FIGS. 5A to 5J, the intestinal tract can be prevented from entering the gap between the insertion assisting tool 70 and the insertion portion 12. The body fluid can be prevented from flowing out of the body cavity from the gap, and the lubricant injected into the gap can be prevented from leaking into the body cavity.

  In the foreign matter collection operation, first, the foreign matter is gripped in front of the insertion portion 12. That is, suction is performed from the forceps port 58 to attract and hold the foreign material, or a treatment tool (not shown) such as a collection net is led out from the forceps port 58 to grip the foreign material.

  Next, the shape memory member 84 is heated to a predetermined temperature or higher by energizing the heater 85. As a result, the shape memory member 84 is deformed into the memorized shape, and the distal end of the insertion assisting tool 70 is in an expanded state as shown in FIG. Therefore, since the diameter d1 of the tip of the insertion assisting tool 70 is sufficiently larger than the outer diameter d3 of the fixing ring 62, the fixing ring 62 is inserted into the insertion assisting tool 70 when the insertion portion 12 is pulled out. The tip of 70 is not caught. Therefore, the insertion part 12 can be smoothly inserted into and removed from the insertion assisting tool 70, and foreign substances can be removed outside the body cavity.

  As described above, according to the present embodiment, since the distal end of the insertion assisting tool 70 is configured to be expandable / contractable, the first balloon 60 is fixed by the fixing ring 62 and a projection is formed on the outer peripheral surface of the insertion portion 12. Even if it is a case, the insertion part 12 can be reliably inserted / extracted with respect to the insertion auxiliary tool 70. FIG. Moreover, according to this Embodiment, since only the insertion part 12 can be inserted / removed, fixing the insertion auxiliary tool 70 to a body cavity, the insertion part 12 can be inserted again and observation or treatment can be performed continuously.

  Furthermore, according to the present embodiment, since the tapers 62A and 62A are provided on the base end sides of the fixing rings 62 and 62, it is possible to more reliably prevent the fixing ring 62 from being caught by the distal end of the insertion assisting tool 70. it can.

  In the above-described embodiment, the shape memory member 84 is deformed into the expanded diameter state when heated, but the present invention is not limited to this, and the shape memory member 84 may be deformed into the reduced diameter state when heated. In the above-described embodiment, the shape memory member 84 is deformed by being heated by the heater 85, but may be deformed by being cooled by a cooling means using a Peltier element or the like.

  In the above-described embodiment, the distal end of the insertion assisting tool 70 is expanded / reduced using the shape memory member 84, but the configuration of the expansion / contraction means is not limited to this. For example, FIG. 6, FIG. 7A, and FIG. 7B are examples in which the diameter of the distal end of the insertion assisting tool 70 is reduced using a constricting wire 88. FIG. A groove 83A is formed on the inner peripheral surface of the cap 83 shown in these drawings so as to make one round in the circumferential direction. By attaching the cap 83 to the distal end portion 73A of the main body tube 73, the groove 83A is attached. The guide hole of the wire 88 is formed in the circumferential direction.

  The wire 88 makes a round so as to surround the distal end portion 73 </ b> A of the main body tube 73, and then passes through the sleeve 89 and is inserted into the hole 87 of the main body tube 73. Then, the wire 88 is pulled out from the hole 87 at the proximal end portion of the insertion assisting tool 70 so that the operator can perform a pulling operation. Further, a locking means (not shown) is provided at the proximal end portion of the insertion assisting tool 70 so that the end portion of the wire 88 can be locked. Note that both ends of the wire 88 may be pulled out from the proximal end of the insertion assisting tool 70 and pulled simultaneously, or one end may be fixed to the sleeve 89 and the other end inserted. You may make it pull out from the base end of the tool 70, and may be made to operate.

  In the insertion aid 70 configured as described above, by pulling the end portion of the wire 88, the ring portion of the wire 88 is narrowed as shown in FIG. 7B, and the distal end portion of the insertion aid 70 is narrowed. . In this state, the distal end of the insertion assisting tool 70 can be maintained in a reduced diameter state by locking the proximal end portion of the wire 88 with locking means (not shown).

  Further, by releasing the lock of the wire 88 and loosening the wire 88, the distal end of the insertion assisting tool 70 is returned to the original state shown in FIG. The tip of the auxiliary tool 70 is expanded in diameter. Thereby, the insertion part 12 can be smoothly inserted and removed from the insertion assisting tool 70.

  In the embodiment described above, as shown in FIG. 4 (a) or FIG. 7 (a), the inner diameter d1 of the distal end of the insertion assisting tool 70 at the time of diameter expansion is substantially the same as the inner diameter d2 of the other portion. However, the present invention is not limited to this. For example, the inner diameter d1 at the time of diameter expansion may be larger than the other parts. Thus, the insertion portion 12 can be more easily pulled into the insertion assisting tool 70 by greatly expanding the diameter of the distal end of the insertion assisting tool 70.

  Moreover, although embodiment mentioned above comprised the front-end | tip part of the insertion auxiliary tool 70 so that expansion / contraction is possible, the part comprised so that expansion / contraction is not limited to a front-end | tip part, for example, the whole inner peripheral surface of the insertion auxiliary tool 70 is comprised. You may comprise so that it may expand / contract.

  Furthermore, although embodiment mentioned above demonstrated in the example which inserts / extracts the insertion part 12 with which the 1st balloon 60 was mounted | worn with respect to the insertion auxiliary tool 70, this invention is not limited to this, All to insert / extract the insertion part 12 It can be applied to the insertion assisting tool 70. However, as in the case where the first balloon 60 is fixed with the fixing ring 62 as described above, or when an endoscope hood described later is attached, an insertion assisting tool for inserting and removing the insertion portion 12 having the protruding portion on the outer peripheral surface. It is particularly effective to apply the present invention to 70.

  Hereinafter, an embodiment in which the endoscope hood is attached to the insertion portion 12 will be described. FIG. 8 is a perspective view showing the tips of the hood 200 and the insertion portion 12. Note that the hood 200 shown in FIG. 8 is an example that also serves as a fixture (fixing ring 62 in FIG. 2) that fixes the distal end portion 60A of the first balloon 60, but the configuration of the hood 200 is not limited to this. Alternatively, the fixture and the hood may be provided separately.

  The hood 200 is formed in a cylindrical shape by an elastic material such as silicon rubber. The hood 200 is formed to be transparent or translucent, and the outside of the hood 200 can be observed by the observation optical system 52 even when the hood 200 is attached to the distal end portion 44 of the insertion portion 12.

  As shown in FIG. 9, the inner diameter d of the hood 200 is formed to be slightly smaller than the outer diameter of the distal end portion 44 of the insertion portion 12, and the distal end portion 44 while elastically deforming the proximal end portion 200 </ b> B of the hood 200. It is attached to the distal end portion 44 by being externally fitted.

  A position restricting portion 202 protrudes from the inner peripheral surface of the hood 200, and the position restricting portion 202 comes into contact with the distal end surface 45 of the insertion portion 12 when the hood 200 is attached to the distal end portion 44. Thereby, the protrusion amount h of the hood 200 at the time of mounting is set to a specified value. The protrusion amount h and the inner diameter d of the hood 200 preferably satisfy the following expression with respect to the radius r (see FIG. 10) of the hemispherical portion of the medical capsule 220.

この式を満たすようにフード２００の先端部２００Ａを構成することによって、医療用カプセル２２０をフード２００の先端部２００Ａに吸着した際に、医療用カプセル２２０が挿入部１２の先端面４５に接触しなくなる。したがって、図１０に示す如く医療用カプセル２２０をフード２００の先端部２００Ａに吸着させた際に、医療用カプセル２２０と先端部２００Ａとの密着状態を保つことができる。これにより、鉗子口５８から吸引を行った際に、フード２００の内部を減圧状態に保つことができ、医療用カプセル２２０を確実に吸着保持することができる。すなわち、フード２００の先端部２００Ａが上記の関係式を満たすことによって、フード２００の先端部２００Ａに医療用カプセル２２０の保持部が形成される。なお、医療用カプセル２２０の形状（すなわちｒの寸法）に応じて、先端開口の内径ｄや突出量ｈの寸法の異なるフード２００を選択するとよい。

By configuring the distal end portion 200A of the hood 200 so as to satisfy this formula, when the medical capsule 220 is adsorbed to the distal end portion 200A of the hood 200, the medical capsule 220 comes into contact with the distal end surface 45 of the insertion portion 12. Disappear. Therefore, as shown in FIG. 10, when the medical capsule 220 is adsorbed to the distal end portion 200A of the hood 200, the medical capsule 220 and the distal end portion 200A can be kept in close contact with each other. Thereby, when suction is performed from the forceps opening 58, the inside of the hood 200 can be kept in a reduced pressure state, and the medical capsule 220 can be reliably sucked and held. That is, when the distal end portion 200A of the hood 200 satisfies the above relational expression, the holding portion of the medical capsule 220 is formed at the distal end portion 200A of the hood 200. In addition, according to the shape (namely, dimension r) of the medical capsule 220, it is good to select the food | hood 200 from which the inside diameter d of the front-end | tip opening and the dimension of the protrusion amount h differ.

  In addition, the length L1 of the hood 200 on the proximal end side from the position restricting portion 202 is the same as the length L2 from the distal end surface 45 of the insertion portion 12 to the mounting position of the distal end portion 60A of the first balloon 60. Yes. Therefore, when the base end portion 200B of the hood 200 is externally fitted to the distal end portion 44 of the insertion portion 12, the base end portion 200B of the hood 200 is externally fitted to the distal end portion 60A of the first balloon 60. The distal end portion 60A of the first balloon 60 is fastened and fixed. That is, the hood 200 has a base end portion 200 </ b> B extending to the attachment position of the tip end portion 60 </ b> A of the first balloon 60, whereby the fixing portion of the first balloon 60 is formed at the base end portion 200 </ b> B.

  The hood 200 configured as described above is attached to the insertion portion 12 as follows. First, as illustrated in FIG. 8, the insertion portion 12 is inserted through the first balloon 60, and the first balloon 60 is disposed at a predetermined position near the distal end portion 44 of the insertion portion 12. Then, the fixing ring 62 is fitted into the rear end portion 60B of the first balloon 60, and the rear end portion 60B of the first balloon 60 is fixed to the insertion portion 12. Next, as shown in FIG. 10, the hood 200 is externally fitted to the insertion portion 12, and the base end portion 200 </ b> B of the hood 200 is externally fitted to the distal end portion 60 </ b> A of the first balloon 60. Accordingly, the distal end portion 60A of the first balloon 60 is fastened and fixed by the proximal end portion 200B of the hood 200.

  9 and 10 is a prism arranged behind the observation optical system 52, and the optical path of the subject light taken in via the observation optical system 52 is bent downward by the prism 53. The Reference numeral 55 denotes a CCD supported on the base 57, and the subject light imaged on the light receiving surface of the CCD 55 is converted into an electrical signal, which is output to the processor 26 in FIG. Further, reference numeral 61 in FIGS. 9 and 10 denotes a pipe 61 supported by the tip body 65, and a tube 63 is connected to the pipe 61, and the tube 63 is connected to the suction connector 49 in FIG. Further, reference numeral 67 in FIGS. 9 and 10 is a cap attached to the distal end surface of the distal end portion main body 65, and reference numeral 69 is an outer skin member that covers the outer peripheral surface of the insertion portion 12.

  Next, a method of holding and transporting the medical capsule 220 in the body cavity using the endoscope 10 equipped with the hood 200 configured as described above will be described. In the following example, an example in which the medical capsule 220 is collected from the deep digestive tract such as the small intestine will be described. However, when the medical capsule 220 caught in the stenosis in the body cavity is transported to the downstream side of the stenosis, It may be used when the medical capsule 220 is held outside and transported to a predetermined position in the body cavity. As for the insertion assisting tool 70, as described above, a tool whose tip is configured to be freely expandable and contractable is used.

  First, the insertion part 12 is inserted into the body cavity with the hood 200 and the first balloon 60 mounted on the insertion part 12. As an insertion method at that time, for example, the operation as shown in FIGS. 5A to 5J is performed, and the distal end portion 44 of the insertion portion 12 is inserted into a deep digestive tract such as the small intestine.

  After inserting the distal end portion 44 of the insertion portion 12 to the position of the medical capsule 220, the distal end portion 200A of the hood 200 is brought close to the medical capsule 220 in the body cavity while viewing the observation image obtained by the observation optical system 52.

  Next, the suction operation from the forceps port 58 is started by operating the suction button 30. Thereby, the gas (or liquid) in the hood 200 is sucked from the forceps port 58, and the inside of the hood 200 is brought into a sucked state. When the inside of the hood 200 is in the suction state, the medical capsule 220 is adsorbed and held by the distal end portion 200A of the hood 200 as shown in FIG.

  After holding the medical capsule 220, the distal end of the insertion assisting tool 70 is expanded in diameter as shown in FIG. 4 (a) or 7 (a), and the insertion portion 12 is pulled out from the insertion assisting tool 70. Thereby, the insertion part 12 can be pulled out with respect to the insertion assisting tool 70 without the hood 200 being caught at the tip of the insertion assisting tool 70.

  As described above, according to the present embodiment, since the distal end of the insertion assisting tool 70 is configured to be expandable / contractable, even when the hood 200 is attached to the insertion part 12, the insertion part 12 is connected to the insertion assisting tool 70. Can be reliably inserted and removed.

  In the hood 200 described above, it is preferable to provide a taper in which the outer diameter on the proximal end side is gradually reduced. Thereby, it can prevent more reliably that the food | hood 200 is caught in the front-end | tip of the insertion auxiliary tool 70. FIG.

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 Exploded perspective view showing the configuration of the tip of the insertion aid Explanatory drawing explaining an effect | action of an insertion auxiliary tool Explanatory drawing which shows the operating method of the endoscope apparatus which concerns on this invention The disassembled perspective view which shows the structure of the front-end | tip part of the insertion auxiliary tool of a structure different from FIG. Explanatory drawing explaining the effect | action of the insertion auxiliary tool of FIG. The perspective view which shows the front-end | tip part of a hood and an insertion part Side surface sectional drawing which shows the hood and insertion part of FIG. Side sectional view showing the insertion part with a hood attached

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Medical capsule, 2 ... Hood member, 3 ... Suction pump, 10 ... Endoscope, 12 ... Insertion part, 14 ... Hand operation part, 26 ... Processor, 50 ... Monitor, 52 ... Observation optical system, 58 ... Forceps Mouth, 60 ... first balloon, 70 ... insertion aid, 80 ... second balloon, 83 ... cap, 84 ... shape memory member, 85 ... heater, 88 ... wire, 89 ... sleeve, 100 ... balloon controller, 200 ... Food, 220 ... Medical capsule

Claims (5)

In an insertion assisting tool for an endoscope that is formed in a cylindrical shape and assists insertion of the insertion portion into a body cavity by inserting the insertion portion of the endoscope.
A guide hole formed in the circumferential direction at the distal end portion of the insertion assisting tool, and a linear member that is inserted through the guide hole and has at least one end extending to the proximal end portion of the insertion assisting tool. The insertion member is narrowed by narrowing the linear member in the guide hole by pulling one end of the linear member, the diameter of the distal end of the insertion assisting tool is reduced, and the insertion by loosening the linear member An insertion assisting tool for an endoscope, comprising an expanding / contracting means for expanding the distal end portion of the assisting tool.   The insertion assisting tool for an endoscope according to claim 1, wherein locking means for locking an end portion of the linear member is provided on a proximal end side of the insertion assisting tool.   2. The endoscope for an endoscope according to claim 1, wherein both ends of the linear member are pulled out from a proximal end of the insertion assisting tool, and the both ends are pulled at the same time. Insertion aid.   The linear member has one end fixed to a sleeve that is inserted through the linear member provided on the distal end side of the insertion assisting tool, and the other end of the linear member is fixed to the insertion assisting tool. The insertion assisting tool for an endoscope according to claim 1, wherein the insertion assisting tool for an endoscope according to claim 1 is pulled out from the proximal end of the endoscope and pulled. An endoscope in which an inflatable and inflatable balloon is attached to the insertion portion, the balloon being fixed by a ring-shaped band, and a cylindrical shape that is inserted into the body cavity of the insertion portion through the insertion portion. as well as aid insertion, and an insertion aid comprising a scaling means for expanding the diameter of the distal end of the insertion assisting tool according to any one of claims 1 to 4, the distal end of the insertion assisting tool in the scaling means An endoscope apparatus, wherein an insertion portion on which the balloon is mounted is inserted into the insertion assisting tool by setting the inner peripheral surface of the portion in an expanded state.

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