JP4776312B2 - Endoscope device - Google Patents

Description

  The present invention relates to an endoscope apparatus, and more particularly to a double balloon type endoscope apparatus for observing a deep digestive tract such as a small intestine.

  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, the endoscope insertion part and the outer peripheral surface of the insertion aid are usually coated with a friction reducing coating to reduce friction when the insertion part and the insertion aid are inserted into and removed from the body cavity. ing.
JP 2002-301019 A

  However, the double-balloon type endoscope apparatus inserts and removes the insertion portion of the endoscope and the insertion assisting tool many times into the body cavity, so that the pharynx of the subject is rubbed when inserted orally. There was a problem that.

  The present invention has been made in view of such circumstances, and an object of the present invention is to provide a double-balloon type endoscope apparatus that can protect the insertion assisting tool from rubbing against a subject.

In order to achieve the above object, the invention according to claim 1 has an insertion portion that is inserted into a body cavity, and an endoscope in which a first balloon that can be expanded and contracted is attached to the outer periphery of the distal end portion of the insertion portion. And a cylindrical insertion assisting tool that guides the insertion of the insertion portion into the body cavity while the insertion portion is inserted, and has a second balloon that can be inflated and contracted on the outer periphery of the distal end portion, and the insertion A protective tube placed on the auxiliary tool; and a fixing means for fixing the protective tube to the subject. The fixing means is a mouthpiece that the subject holds, and the protective tube is the insertion piece. It is softer than an assisting device.

According to the first aspect of the present invention, since the insertion assisting tool is covered with the protective tube and fixed to the subject, when the insertion assisting tool is inserted and removed, the insertion assisting tool is a constricted portion of the subject's digestive tract ( There is no risk of rubbing the pharynx, for example. At this time, when the subject holds the mouthpiece, the protective tube can be fixed to the subject. Moreover, since a softer protection tube than the insertion assisting tool is used, there is no possibility that the insertion / extraction operability of the insertion assisting tool will be impaired. Therefore, according to the invention of claim 1, the pain of the subject can be eased.

In invention endoscope apparatus according to claim 1 of claim 2, together with the flange portion to the mouthpiece which projects in a radial direction is formed, the fixed cylinder on an end portion of the protective tube is mounted An engaging portion corresponding to the shape of the flange portion is provided at the end of the fixed tube, and the fixed tube is moved forward and backward relative to the mouthpiece along the axial direction of the protective tube. Thus, the flange portion is configured to be detachable between a mounted state in which the flange portion is engaged with the engaging portion and a non-mounted state in which the engagement is released.

According to a third aspect of the present invention, in the first or second aspect of the present invention, at least a portion constituting the inner peripheral surface of the protective tube is made of a fluororesin. According to the invention described in claim 3 , since the inner peripheral surface of the protective tube is made of polytetrafluoroethylene having good slipperiness, the insertion aid can be smoothly inserted and removed. The base material of the protective tube may be made of fluororesin, or the inner peripheral surface of the protective tube may be coated with fluororesin.

According to the present invention, since the insertion assisting device is covered with the protective tube and fixed to the subject, when the insertion assisting device is inserted and removed, the insertion assisting device is narrowed in the subject's digestive tract (for example, the pharyngeal portion). ) At this time, when the subject holds the mouthpiece, the protective tube can be fixed to the subject. Moreover, since a softer protection tube than the insertion assisting tool is used, there is no possibility that the insertion / extraction operability of the insertion assisting tool will be impaired. Therefore, the pain of the subject can be eased.

  A preferred embodiment of 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 embodiment of an endoscope apparatus according to the present invention. As shown in FIG. 1, the endoscope apparatus includes an endoscope 10, an insertion aid 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 operation 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 58 are provided on the distal end surface 45 of the distal end portion 44. 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 48 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 connector 48 to supply air and 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. Therefore, by connecting the suction pump 51 to the suction connector 49 and operating the valve with the suction button 30, a lesioned part or the like can be sucked from the forceps port 58.

  A first balloon 60 made of an elastic material 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 62 and 62 into both ends of the 60.

  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. 1, and is connected to the balloon control device 100 via a tube 110 described later. 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 grip portion 72.

  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). For example, polyvinyl pyrrolidone is used as the hydrophilic coating material.

  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 substantially cylindrical shape with both ends narrowed, and is attached 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.

  The balloon control device 100 of FIG. 1 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 the endoscope control system and the insertion assisting tool control system, respectively. When only one is used, the function stop switches SW3 and SW4 which are not used are operated to turn off the function. In a control system whose 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.

  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.

  Incidentally, the endoscope apparatus according to the present invention includes the protective tube 150 shown in FIGS. 3 and 4. The protective tube 150 includes a flexible tube 152 and a hard fixed cylinder 154 provided at an end of the tube 152. As shown in FIG. 4, the inner diameter D <b> 1 of the tube 152 is slightly larger than the outer diameter D <b> 2 of the tube 73 of the insertion assisting tool 70. Further, the tube 152 is made of a material having good slipperiness, for example, Teflon. Therefore, when the insertion assisting tool 70 is inserted into and removed from the tube 152, the tube 152 and the insertion assisting tool 70 slide smoothly, so that the insertion / extraction operation can be performed smoothly. Note that a lubricant may be supplied between the inner peripheral surface of the tube 152 and the outer peripheral surface of the insertion assisting tool 70. Thereby, the friction between the tube 152 and the insertion assisting tool 70 can be further reduced, and the insertion / extraction operation of the insertion assisting tool 70 can be performed more smoothly.

  In addition, it is preferable that the tube 152 has a rigidity that does not turn when the insertion assisting tool 70 is inserted and removed, and is thinned as much as possible under the conditions. Further, the length in the direction of the tube 152 is set so that the tube 152 is arranged in the portion of the pharynx 90D of the subject when the subject holds the mouthpiece 160 (see FIG. 6) described later. .

  An end portion of the tube 152 is externally fitted to the fixed cylinder 154 and is fixed by an adhesive. The fixed cylinder 154 is formed in a cylindrical shape with resin, and a flange 154A is formed at an end thereof. The flange 154A has a shape folded at the outer peripheral portion thereof, and includes an engaging portion 154B that protrudes inward. By engaging the engaging portion 154B with the flange 160B of the mouthpiece 160, the mouthpiece 160 is attached to the fixed cylinder 154.

  As shown in FIG. 6, the mouthpiece 160 is a member that the subject holds in the mouth, and is formed in a cylindrical shape from resin. Flange 160A and 160B are formed at both ends of the mouthpiece 160, respectively, so that the mouthpiece 160 is not swallowed when the subject holds it. Further, as described above, the flange 160B is configured to be engageable with the engaging portion 154B of the fixed cylinder 154, and the flange 160B is engaged with the engaging portion 154B by sliding the mouthpiece 160 in the arrow A direction. In combination, the mouthpiece 160 is attached to the fixed cylinder 154. Further, by sliding the mouthpiece 160 in the arrow B direction, the engagement between the flange 160B and the engaging portion 154B is released, and the mouthpiece 160 can be detached from the fixed cylinder 154.

  In addition, the shape of the fixed cylinder 154 and the mouthpiece 160 is not limited to a cylindrical shape, and may be formed in a cylindrical shape having a cross section of an ellipse or an ellipse, for example.

  Next, an operation method of the endoscope apparatus configured as described above will be described with reference to FIGS. 5, 6, and 7 (a) to 7 (j).

  First, as shown in FIG. 5, in a state where the first balloon 60 and the second balloon 80 are deflated, the insertion assisting tool 70 is inserted through the protective tube 150, and the insertion assisting instrument 70 is inserted through the insertion portion 12. At that time, the protective tube 150 and the mouthpiece 160 are separated, and the mouthpiece 160 is added to the subject.

  In this state, the insertion of the insertion portion 12 is started, and when the distal end of the insertion portion 12 reaches the stomach 90A as shown in FIG. 7A, the insertion assisting tool 70 is inserted along the insertion portion 12. To do. At that time, the protective tube 150 is inserted together with the insertion assisting tool 70, and when the proximal end of the protective tube 150 reaches the subject's mouth as shown in FIG. The stationary tube 154 of the protective tube 150 is engaged with the mouthpiece 160. Thereby, the protective tube 150 is fixed to the subject via the mouthpiece 160. Therefore, the subject's pharynx 90D is protected by the protective tube 150.

  Next, the insertion of the insertion assisting tool 70 is resumed, and as shown in FIG. 7B, the distal end of the insertion assisting tool 70 reaches the inside of the stomach 90A. Next, the insertion portion 12 is pushed into the insertion assisting tool 70 in a state where the insertion assisting tool 70 is gripped so as not to come out of the body cavity. Then, as shown in FIG. 7 (c), after insertion until the distal end of the insertion portion 12 reaches the descending leg 90B of the duodenum (insertion operation), the first balloon 60 is inflated, and the distal end of the insertion portion 12 is placed under the duodenum. It fixes to the pedestal 90B (fixing operation).

  Next, by inserting the insertion assisting tool 70, the insertion assisting tool 70 is inserted along the insertion portion 12 (pressing operation). At that time, as shown in FIG. 6, the subject's pharynx 90D is protected by a protective tube 150 fixed to the subject, and there is no possibility that the insertion aid 70 slides on the subject's pharynx 90D. . Thus, the pain of the subject can be eased.

  As shown in FIG. 7D, after the distal end 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. At that time, as described above, the pharynx of the subject is protected by the protective tube 150, so that the insertion assisting tool 70 does not slide on the pharynx of the subject and the pharynx is not rubbed. .

  Next, after air is sucked from the first balloon 60 to contract the first balloon 60, the insertion portion 12 is advanced to the inside of the small intestine 90C as shown in FIG. 7E (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. 7 (f), the first balloon 60 is inflated to fix the distal end of the insertion portion 12 to the digestive tract 90. Then, after the second balloon 80 is deflated, as shown in FIG. 7G, 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. 7 (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. 7 (j), the insertion portion 12 can be inserted deeper into the digestive tract 90.

  In the above-described operation, the insertion assisting tool 70 is repeatedly inserted into and removed from the subject. For this reason, in the conventional apparatus without the protective tube 150, the insertion assisting tool 70 is rubbed against the subject's pharynx 90D many times, which causes pain to the subject.

  On the other hand, according to the endoscope apparatus of the present embodiment, the protective tube 150 is provided outside the insertion assisting tool 70, and this protective tube 150 is fixed to the subject via the mouthpiece 160. Even when the insertion assisting tool 70 is inserted / extracted, the subject's pharynx 90D is always protected by the protective tube 150, and there is no possibility that the insertion assisting tool 70 will rub against the subject's pharynx 90D. Therefore, the pain of the subject 90 can be eased.

  In the above-described embodiment, the protective tube 150 is fixed to the subject by the mouthpiece 160. However, the present invention is not limited to this, and a holding means for the protective tube 150 may be separately provided. For example, the protective tube 150 may be held and fixed by the tip of an arm fixed to the examination table.

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 Perspective view showing the protective tube Sectional view showing the configuration of the protective tube The perspective view which shows the use condition of a protection tube Explanatory drawing showing the action of the protective tube 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, 20 ... Light source device, 26 ... Processor, 50 ... Monitor, 60 ... 1st balloon, 70 ... Insertion aid, 80 ... 2nd balloon, 150 ... Protective tube, 152 ... tube, 154 ... fixed cylinder, 160 ... mouthpiece

Claims (3)

An endoscope having an insertion portion to be inserted into a body cavity, and having a first balloon which can be inflated and contracted on the outer periphery of the distal end portion of the insertion portion;
A cylindrical insertion aid that guides the insertion of the insertion portion into the body cavity in a state where the insertion portion is inserted, and has a second balloon that can be expanded and contracted on the outer periphery of the distal end portion;
A protective tube placed over the insertion aid;
Fixing means for fixing the protective tube to the subject;
With
The fixing means is a mouthpiece that the subject holds,
The endoscope apparatus characterized in that the protective tube is softer than the insertion assisting tool. The mouthpiece is formed with a radially projecting flange portion, and a fixed tube is attached to the end of the protective tube, and the end of the fixed tube is engaged with the shape of the flange portion. And the engagement state in which the flange portion is engaged with the engagement portion by moving the fixed cylinder forward and backward relative to the mouthpiece along the axial direction of the protective tube. The endoscope apparatus according to claim 1 , wherein the endoscope apparatus is configured to be attachable and detachable with respect to a non-wearing state in which is released. The endoscope apparatus according to claim 1 or 2 , wherein at least a portion of the protective tube constituting the inner peripheral surface is made of a fluororesin.

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