JP5380601B2 - Endoscope device - Google Patents

Description

  The present invention relates to an endoscope apparatus.

Bile and pancreatic duct endoscopes that are inserted into the bile duct and pancreatic duct for observation are used for diagnosis such as stenosis of the bile duct and pancreatic duct and benign / malignant differentiation of raised lesions. The bile and pancreatic duct endoscope (child endoscope) has a thin insertion portion of about 3 mm, and this insertion portion is inserted into the forceps opening of a normal endoscope (parent endoscope). used. The child endoscope is inserted into the duodenum after inserting the distal end of the parent endoscope into the duodenum, and then the child endoscope is extended from the distal end of the parent endoscope, and the insertion portion of the child endoscope is moved into the duodenum. Insert into the bile duct and pancreatic duct from the nipple. In this way, observation of the bile duct and the pancreatic duct becomes possible by operating the two endoscopes, the parent endoscope and the child endoscope, respectively (Patent Document 1).
However, in order to operate two endoscopes at the same time, an operator of each endoscope is required, and since both endoscopes are operated in cooperation with each other, the procedure contents become complicated and skill is increased. It was necessary. Therefore, there is a demand to introduce and observe the bile duct and pancreatic duct simply with one endoscope, but in order to insert the endoscope insertion part into the duodenal papilla, a corresponding thinness is required, A small-sized bile and pancreatic duct endoscope itself cannot reach from the oral cavity to the duodenum.
Patent Document 2 describes an endoscope that has improved insertion property into a constricted body cavity tube by projecting the distal end portion of the endoscope into a spatula shape. In this endoscope, the tapered distal end portion of the endoscope is inserted while being pressed against a living tissue.

JP 2010-63772 A JP 2004-351138 A

  However, even in the endoscope of Patent Document 2, when the endoscope distal end is inserted into a particularly narrow body cavity tube such as the bile duct or pancreatic duct, the observation window is arranged at the tapered distal end. It is actually difficult to aim and push forward. In other words, even if the distal end of the endoscope is pushed forward while observing, it may advance in an unexpected direction, requiring a delicate operation and requiring skill in insertion work.

  In the present invention, when the distal end of the endoscope insertion portion is inserted into a body cavity such as a very small diameter bile or pancreatic duct, it can be easily and smoothly inserted while aiming at a desired position. An object of the present invention is to provide an endoscope apparatus.

The present invention has the following configuration.
A forceps port through which the treatment tool is inserted, an observation window for observing the subject, and an illumination window for emitting illumination light are arranged on the distal end surface of the endoscope insertion portion having a bending portion capable of bending operation. An endoscopic device,
A part of the distal end surface of the endoscope insertion portion is formed to protrude from the axial distal end of the endoscope insertion portion,
A part of the protruding tip surface is arranged at a position that fits within the observation field of view from the observation window,
An operation portion provided on the proximal end side of the endoscope insertion portion, and an operation wire arranged along the endoscope insertion portion and transmitting an operation to the operation portion to the bending portion by tension,
When the curved portion section is defined by a plane perpendicular to the longitudinal axis of the endoscope insertion portion and the curved portion cross section is divided into two regions by a straight line passing through the center of the curved portion cross section. , And can be divided into a first region where the operation wire exists and a second region where the operation wire does not exist,
The observation window is arranged in a first tip projection region in which the first region where the operation wire exists is projected onto the tip surface of the tip of the endoscope insertion unit, and the second region is used as the endoscope insertion unit. An endoscope apparatus in which a second tip projection area projected onto a tip surface of the tip projects outward in the longitudinal axis direction of the endoscope insertion portion.

  According to the endoscope apparatus of the present invention, when inserting into a body cavity such as a very small diameter bile / pancreatic duct, it is possible to easily and smoothly insert it while aiming at a desired position.

It is a figure for demonstrating embodiment of this invention, and is an external view of an endoscope apparatus. It is a perspective view of the endoscope front-end | tip part shown in FIG. It is an expanded sectional view of the curved curved part of the endoscope apparatus shown in FIG. FIG. 3 is a front view of a distal end surface when the endoscope distal end portion illustrated in FIG. 2 is viewed from the front. It is the front view of the duodenum vicinity, and the principal part enlarged view which notched the part. (A) is a side view of the distal end portion of the endoscope facing the duodenal papilla during a body cavity incision, and (B) is a side view of the distal end portion of the endoscope inserted into the bile duct. It is explanatory drawing which shows the image of the observation visual field obtained by imaging from an observation window.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a view for explaining an embodiment of the present invention, and is an external view of an endoscope apparatus.
The endoscope apparatus 100 includes an endoscope operation unit 11 and an endoscope insertion unit 13 that is connected to the endoscope operation unit 11 and is inserted into a body cavity. A universal cord 15 including various pipes and signal cables is connected to the endoscope operation unit 11, and a connector that is detachably connected to a control device (not shown) is attached to the distal end of the universal cord 15. ing. Various buttons 17 such as an air supply / water supply button, a suction button, a shutter button, and a function switching button are arranged in parallel in the endoscope operation unit 11, and a curve provided on the distal end side of the endoscope insertion unit 13. An angle knob 21 for bending the portion 19 is provided.

  The endoscope insertion unit 13 includes a flexible portion 23, a bending portion 19, and an endoscope distal end portion 25 in order from the endoscope operation unit 11 side. The flexible portion 23 has flexibility and is continuously provided from the endoscope operation portion 11 to the proximal end side of the bending portion 19. In addition, the bending portion 19 performs a bending operation by pulling the operation wire 27 inserted in the endoscope insertion portion 13 by rotating the angle knob 21 of the endoscope operation portion 11. Yes. Thereby, the endoscope front-end | tip part 25 can be turned to a desired direction.

  A treatment instrument insertion section 33 for a forceps channel 31 into which a tube such as a treatment instrument or a water supply means is inserted is provided in the continuous section 29 between the endoscope operation section 11 and the endoscope insertion section 13. The forceps channel 31 is formed so that various treatment tools such as a high-frequency knife can be inserted from the endoscope distal end portion 25 to the endoscope operation portion 11.

FIG. 2 is a perspective view of the endoscope distal end portion 25 shown in FIG.
In the endoscope apparatus 100, a forceps port 37 through which a treatment tool is inserted and an observation window 39 for observing a subject are arranged on the distal end surface 35 of the endoscope distal end portion 25. In addition, a pair of illumination windows 41 are arranged at the endoscope distal end portion 25 with the observation window 39 interposed therebetween. The illumination light emitted from the illumination window 41 illuminates the subject, and an observation image of the illuminated subject is acquired through the observation window 39. Illumination light emitted from the illumination window 41 is supplied from a light source (not shown) to the endoscope apparatus 100 through the universal cord 15 shown in FIG. 1, and is emitted from the illumination window 41 through a light guide that is a light guide member.

FIG. 3 is an enlarged cross-sectional view of the curved bending portion 19 of the endoscope apparatus 100 shown in FIG.
The endoscope distal end portion 25 has a cylindrical distal end rigid portion 43 made of a hard material such as ceramic or stainless steel. A housing portion 44 is formed in a part of the distal end rigid portion 43, and an imaging optical system 45 is fixed in the housing portion 44.

  The imaging optical system 45 includes an imaging element 49 that images an observation site illuminated by the illumination optical system, a substrate 51 on which the imaging element 49 is mounted, a condensing lens 55, and a prism 59. An imaging signal of an observation image obtained from 49 is output to a control device (not shown) through a signal line 53 connected to the substrate 51. The control device displays image information obtained by performing image processing on the input imaging signal on a monitor (not shown). As the imaging element 49 of the imaging optical system 45, a CCD (Charge Coupled Device) type image sensor or a CMOS (Complimentary Metal Oxide Semiconductor) image sensor can be used.

  The prism 59 is disposed so as to face the light receiving surface 57 of the image sensor 49, and forms an image of light taken from the condenser lens 55 on the image sensor 49 mounted on the substrate 51 by changing the optical path to a right angle. An image signal based on the image information captured by the image sensor 49 is output through a signal line 53 connected to the substrate 51. The prism 59 arranges the image sensor 49 in parallel with the central axis of the endoscope tip 25, and accommodates the image sensor 49 and the condenser lens 55 in the endoscope tip 25 in a space-efficient and compact manner.

FIG. 4 is a front view of the distal end surface 35 when the endoscope distal end portion 25 shown in FIG. 2 is viewed from the front.
When the endoscope distal end portion 25 is viewed from the front, the pair of illumination windows 41 and 41 are respectively arranged at positions that are line-symmetric with respect to the first straight line 61 that passes through the center of the observation window 39 and the forceps port 37. ing.

  The endoscopic device 100 includes a straight line 69 passing through the center of the bending portion cross section 67 in the bending portion cross section 67 in which the bending portion 19 shown in FIG. 3 is defined by a plane orthogonal to the longitudinal axis of the endoscope insertion portion 13. The curved section 67 can be divided into two regions. That is, it can be divided into a first region 71 where the operation wire 27 exists and a second region 73 where the operation wire 27 does not exist.

  An observation window 39 is arranged in a first tip projection region 77 in which the first region 71 where the operation wire 27 exists is projected onto the tip surface 35 at the tip of the endoscope insertion portion. A forceps port 37 is disposed in the second tip projection region 79 obtained by projecting the second region 73 onto the tip surface 35 at the tip of the endoscope insertion portion, and protrudes outward in the longitudinal axis direction of the endoscope insertion portion 13. Yes. Therefore, when the bending portion 19 is bent by the pulling operation of the operation wire 27, the observation window 39 is positioned inside the bending portion 19 as shown in FIG. The part 81 and the forceps port 37 are located.

  Further, after the bending portion 19 is operated to bend by pulling the operation wire 27 and then released from the bending, if the operation wire 27 is loosened by operating the angle knob 21, the resin forming the forceps channel 31 of the forceps opening 37 is formed. The elastic restoring force of the made forceps tube 65 (see FIG. 3) acts to return to a straight shape.

The endoscope distal end portion 25 having the above configuration will be described in more detail.
As shown in FIG. 2, a tongue piece 85 formed in a flat shape is provided on a part 81 of the tip surface that protrudes from the tip in the axial direction. The tongue 85 is arranged at a position that falls within the observation visual field range φ from the observation window 39. The tongue 85 has a tapered surface that is formed on a part of the outer periphery of the distal end of the endoscope distal end 25 with a smoothly curved tip and gradually becomes wider toward the observation window 39 side. Further, the surface of the tongue piece 85 is smoothly connected to the outer peripheral surface 89 of the endoscope distal end portion 25 without forming a stepped portion.

  As described above, the observation window 39 is arranged in the seventh tip projection region 77 that is inside the curve by the bending operation using the operation wire 27, and protrudes in the axial direction in the second tip projection region 79 that is outside the curve. The tongue piece 85 is arranged. Thereby, the state in which the tongue piece 85 is pressed against the subject surface can be observed from the observation window 39 including the tongue piece 85.

  According to this configuration, when the endoscope distal end portion 25 is pushed forward, the endoscope distal end portion 25 can be moved to a desired position using the tongue piece 85 pressed against the subject surface as a guide. That is, when the endoscope distal end portion 25 is inserted into a narrow body cavity tube, the tongue piece 85 can be surely inserted into the narrow tube while visually recognizing it. The entire mirror tip 25 can be inserted smoothly.

  The protruding tongue piece 85 is preferably made of a translucent member. The area pressed by the tongue piece 85 on the surface of the subject can be observed through the tongue piece 85, and the position can be easily confirmed. In addition, the tongue piece 85 spreading in a narrow tube does not block the visual field in the tube. As a result, observation in a narrow tube can be performed reliably, and a more accurate procedure is possible.

  As described above, the shape of the endoscope distal end portion 25 is tapered from the outer peripheral surface 89 of the endoscope insertion portion 13, and the taper is cut obliquely to become the distal inclined surface 91. Therefore, the tip inclined surface 91 is an ellipse with a narrow width on the tip side of the endoscope (an ellipse having a major axis in the direction along the axial direction of the endoscope insertion portion 13). The width is preferably further narrowed. Further, the tip inclined surface 91 is preferably chamfered so as not to have a corner portion, and the tip inclined surface 91 is preferably rounded and bulged to improve the insertability. .

  The illumination windows 41, 41 are arranged in the middle position from the observation window 39 to the forceps opening 37 on the inclined front end surface 35. Thereby, it becomes possible to arrange the pair of illumination windows 41 and 41 using the extra space formed on both sides of the boundary portion where the observation window 39 and the forceps opening 37 approach each other, and the limited endoscope distal end portion 25. It is possible to efficiently arrange the front end surface 35 without generating a useless space.

  The observation window 39 and the illumination window 41 have an outer surface 93 (see FIG. 2) that is inclined along the distal end surface 35. A cover lens is disposed on the observation window 39 and the illumination window 41, and an outer surface 93 of the cover lens is disposed on the same plane as the tip inclined surface 91. The outer surface 93 is formed along the tip inclined surface 91 if the tip inclined surface 91 is a bulging surface. With such a configuration, the observation window 39 and the illumination window 41 are also part of the tip inclined surface 91, and smooth insertion is possible.

Next, the operation of the endoscope apparatus 100 having the above-described configuration will be described by taking an endoscopic examination of the bile duct 87 as an example.
FIG. 5 is a front view of the vicinity of the duodenum and an enlarged view of a main part with a part thereof cut away.
In the endoscope apparatus 100, the endoscope distal end portion 25 is inserted to the position of the duodenum 95 by the operator. A common tube 99 in which a bile duct 87 and a pancreatic duct 97 are connected is connected to the duodenum 95, and a duodenal papilla 101 is opened at the connection site.

6A is a side view of the endoscope distal end portion 25 facing the duodenal papilla during a body cavity incision, and FIG. 6B is a side view of the endoscope distal end portion 25 inserted into the bile duct 87.
The surgeon operates the angle knob 21 to bend the bending portion 19 and places the endoscope distal end portion 25 facing the duodenal papilla as shown in FIG. 6 (A).

  The surgeon projects the high-frequency knife 88 from the forceps opening 37 (see FIG. 2) and incises the duodenal papilla 101 with the high-frequency knife 88 while viewing the captured image obtained through the observation window 39.

  At that time, according to the present configuration, the duodenal papilla that will be located inside the curve is incised, so that the observation visual field is secured without hiding the boundary between the incised part and the unincised part, and the procedure using the treatment tool Can be easily observed.

  When the incision of the duodenal papilla 101 is completed, the operator inserts the endoscope distal end portion 25 into the incised duodenal papilla 101 and inserts it from the common tube 99 into the bile duct 87 as shown in FIG. Then, endoscopic observation in the bile duct 87 is performed. At this time, the tongue piece 85 can be used to push and widen the entrance of the bile duct 87 to reliably guide the insertion of the endoscope distal end portion 25.

  FIG. 7 is an explanatory diagram showing an image of the observation field obtained by imaging from the observation window 39. A tongue piece 85 is projected in the observation field of view from the observation window 39. The tongue piece 85 aligns the duodenal papilla 101 serving as the insertion destination with the position of the endoscope tip so that the internal insertion point is located at the target insertion destination. The tip of the endoscope can be easily advanced.

  Further, in the observation with the endoscope distal end portion 25 inserted into the common tube 99 and the bile duct 87, it is preferable to supply and discharge a transparent fluid such as physiological saline in order to improve the deterioration of the visual field due to yellowish bile. . At this time, since the forceps port 37 is arranged following the tongue piece 85, the transparent fluid is quickly supplied and discharged from the forceps port 37, and the observation field of view from the observation window 39 can be secured. The same applies when an endoscope is inserted into the pancreatic duct 97.

  In this way, in the endoscope apparatus 100, by projecting a part of the distal end surface of the endoscope insertion portion 13, it is possible to smoothly guide insertion of an endoscope into a particularly narrow body cavity tube, and a reliable endoscope. Insertion procedure can be performed. Also, since the distal end surface portion 81 is disposed at a position that falls within the observation visual field range φ, the insertion tip is aimed and the endoscope distal end portion 25 is pushed forward by using the projected distal surface portion 81 as a guide. be able to. Therefore, it is easy to determine the force of the insertion work and the direction in which the force is applied, and the insertion work into a narrow bile duct 87 is facilitated.

  Therefore, according to the endoscope apparatus 100 having the above-described configuration, when the distal end portion of the endoscope is inserted into a body cavity tube such as a narrow bile / pancreatic duct, it is easy to insert the endoscope at a desired position with certain aim. And it can be done smoothly. Thereby, the utilization range of an endoscope apparatus can be expanded.

  The present invention is not limited to the above-described embodiments, and those skilled in the art can change or apply the present invention based on the description of the specification and well-known techniques. included. For example, the tongue piece 85 described above may be formed in a cone shape or a rod shape in addition to the flat shape.

As described above, the following items are disclosed in this specification.
(1) A forceps port through which a treatment tool is inserted, an observation window for observing a subject, and an illumination window for emitting illumination light are arranged on the distal end surface of an endoscope insertion portion having a bending portion capable of bending operation. An endoscopic device,
A part of the distal end surface of the endoscope insertion portion is formed to protrude from the axial distal end of the endoscope insertion portion,
A part of the protruding tip surface is arranged at a position that fits within the observation field of view from the observation window,
An operation portion provided on the proximal end side of the endoscope insertion portion, and an operation wire arranged along the endoscope insertion portion and transmitting an operation to the operation portion to the bending portion by tension,
When the curved portion section is defined by a plane perpendicular to the longitudinal axis of the endoscope insertion portion and the curved portion cross section is divided into two regions by a straight line passing through the center of the curved portion cross section. , And can be divided into a first region where the operation wire exists and a second region where the operation wire does not exist,
The observation window is arranged in a first tip projection region in which the first region where the operation wire exists is projected onto the tip surface of the tip of the endoscope insertion unit, and the second region is used as the endoscope insertion unit. An endoscope apparatus in which a second tip projection area projected onto a tip surface of the tip projects outward in the longitudinal axis direction of the endoscope insertion portion.
According to this endoscope apparatus, a part of the distal end surface of the endoscope insertion portion protrudes toward the axial distal end, and a part of the distal end surface is disposed within the observation field of view. It is possible to set a target and push a part of the protruding tip surface as a guide. Accordingly, insertion can be performed while observing the state of pressing against the subject surface, the force adjustment and the direction of force application can be easily determined, and the insertion work of the endoscope distal end into a narrow body cavity tube is facilitated.
In addition, according to this endoscope apparatus, the observation window is arranged in the first tip projection area where the operation wire exists, and a part of the tip surface protruding to the second tip projection area is arranged. Therefore, when the operation wire is bent, the observation window is positioned inside the curve, and a part of the tip surface protruding outward is positioned.

(2) The endoscope apparatus according to (1), wherein a part of the protruding front end surface is a tongue piece formed in a flat shape.
According to this endoscope apparatus, a part of the protruding distal end surface becomes a tongue piece, so that it becomes easy to insert the distal end portion of the endoscope by pushing the inside of the narrow body cavity tube.

(3) The endoscope apparatus according to (1) or (2), wherein a part of the protruding front end surface is made of a translucent member.
According to this endoscope apparatus, a portion where a part of the distal end surface is pressed against the surface of the subject can be observed through a portion of the distal end surface, and the distal end surface is pushed and expanded in a narrow body cavity tube Does not obstruct the observation visual field in the body cavity tube. Thereby, a favorable observation visual field can always be ensured.

(4) The endoscope apparatus according to any one of (1) to (3), wherein the observation window and the illumination window have an inclined outer surface along the distal end surface.
According to this endoscope apparatus, the observation window and the illumination window are also part of the inclined surface, and smooth insertion is possible.

(5) The endoscope apparatus according to any one of (1) to (4), wherein the forceps port is arranged in the second tip projection region.
According to this endoscope apparatus, when the bending portion is bent by the operation of the operation wire, the observation window is positioned on the inner side of the curve, and a part of the protruding tip surface is positioned on the outer side. Is located. For this reason, the treatment tool protruding from the forceps opening can be seen from the inside of the curve. For example, when the duodenal papilla that is located inside the curve is incised, the boundary between the incised part and the unincised part is hidden by the treatment tool The field of view is ensured and the procedure using the treatment tool can be easily observed.

(6) The endoscope apparatus according to any one of (1) to (5), wherein an imaging optical system is disposed inside the observation window, and the imaging optical system includes a condenser lens, an imaging element, An endoscope apparatus comprising: a prism that is disposed opposite to a light receiving surface of the imaging element and guides imaging light from the condenser lens to the light receiving surface by bending an optical axis at a right angle.
According to this endoscope apparatus, the image pickup device and the condenser lens arranged inside the observation window can be accommodated in a space-efficient and compact manner.

(7) The endoscope apparatus according to any one of (1) to (6), wherein the illumination window is disposed at a middle position from the observation window to the forceps opening on the inclined distal end surface. Endoscopic device.
According to this endoscope apparatus, it becomes possible to arrange a pair of illumination windows by using the extra space formed on both sides of the boundary portion where the observation window and the forceps opening approach each other, and the limited endoscope An efficient arrangement that does not cause useless space on the distal end surface of the distal end portion is possible.

DESCRIPTION OF SYMBOLS 11 Endoscope operation part 13 Endoscope insertion part 19 Bending part 27 Operation wire 35 Tip surface 37 Forceps opening 39 Observation window 41 Illumination window 45 Imaging optical system 49 Imaging element 55 Condensing lens 57 Light receiving surface 59 Prism 67 Section of bending part 69 Straight line passing through center 71 First region 73 Second region 77 First tip projection region 79 Second tip projection region 81 Part of projected tip surface 85 Tongue piece 89 Outer peripheral surface 91 Tip inclined surface 93 Outer surface 100 Endoscope device

Claims (7)

A forceps port through which the treatment tool is inserted, an observation window for observing the subject, and an illumination window for emitting illumination light are arranged on the distal end surface of the endoscope insertion portion having a bending portion capable of bending operation. An endoscopic device,
A part of the distal end surface of the endoscope insertion portion is formed so as to protrude from the axial distal end of the endoscope insertion portion,
A part of the protruding tip surface is disposed at a position that falls within the observation field of view from the observation window,
An operation portion provided on the proximal end side of the endoscope insertion portion, and an operation wire arranged along the endoscope insertion portion and transmitting an operation to the operation portion to the bending portion by tension,
When the curved portion section is defined by a plane perpendicular to the longitudinal axis of the endoscope insertion portion, the curved portion cross section is divided into two regions by a straight line passing through the center of the curved portion cross section. , And can be divided into a first region where the operation wire exists and a second region where the operation wire does not exist,
The observation window is arranged in a first tip projection region obtained by projecting the first region where the operation wire exists on the tip surface of the tip of the endoscope insertion unit, and the second region is used as the endoscope insertion unit. An endoscope apparatus in which a second tip projection area projected onto a tip surface of the tip protrudes outward in the longitudinal axis direction of the endoscope insertion portion. The endoscope apparatus according to claim 1,
An endoscope apparatus in which a part of the protruding front end surface is a tongue piece formed in a flat shape. The endoscope apparatus according to claim 1 or 2,
An endoscope apparatus in which a part of the protruding front end surface is made of a translucent member. The endoscope apparatus according to any one of claims 1 to 3,
An endoscope apparatus in which the observation window and the illumination window have an inclined outer surface along the distal end surface. The endoscope apparatus according to any one of claims 1 to 4,
An endoscope apparatus in which the forceps port is arranged in the second tip projection region. The endoscope apparatus according to any one of claims 1 to 5,
An imaging optical system is arranged inside the observation window,
The imaging optical system is a condensing lens, an imaging device, and a prism that is disposed to face the light receiving surface of the imaging device and guides imaging light from the condensing lens to the light receiving surface by bending an optical axis at a right angle. And an endoscope apparatus. The endoscope apparatus according to any one of claims 1 to 6,
An endoscope apparatus in which the illumination window is disposed at a middle position from the observation window to the forceps opening on the inclined front end surface.

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