JP2016083270A - Medical endoscope apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To make it possible to bend beforehand a curved section manually to be as compact as possible and to make the distal end face of an insertion tube face accurately to an observation object without damaging tissue of a subject in inserting the insertion tube into the subject.SOLUTION: An insertion tube 1 insertable into a subject is comprised of a distal end part 2 with a distal end face 2a formed as an observation window to observe an observation target site, a curved section 3 connected to the proximal end side of the distal end part 2, and a flexible part 4 connected to the proximal end side of the curved section 3. The curved section 3 is configured to be manually bendable and to maintain a bent shape so as to allow for insertion into a subject. In addition, a guide tube 30 is provided, the guide tube having a tube body 31 which allows the whole or part of the curved section 3 of the insertion tube 1 to protrude from the distal end 30a when the insertion tube 1 is inserted forward and backward movable and is moved forward and backward, and the tube body 31 is configured to be manually bendable and to maintain a bent shape.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical endoscope apparatus that is used for surgery or examination in the medical field and that is inserted into a subject to perform endoscopic observation, and in particular, a medical endoscope apparatus in which a distal end portion can be bent. About.

  Conventionally, as shown in FIG. 6, as this type of medical endoscope apparatus Sa, for example, an insertion tube 100 that can be inserted into a body cavity of a subject, and an operation unit connected to the proximal end of the insertion tube 100 101. The insertion tube 100 includes a hard distal end portion 102 having a distal end surface 102 a formed as an observation window of the observation target portion, a bending portion 103 connected to the proximal end side of the distal end portion 102, and a proximal end side of the bending portion 103. Are connected in a row with the flexible portion 104 connected to the. The flexible portion 104 is flexibly followed by applying an external force of a certain level or more, and exhibits flexibility, and the bending portion 103 is predetermined by an operation of an operation lever (not shown) of the operation portion 101. Bend and deform in the direction. In the distal end portion 102 of the insertion tube 100, an objective lens (not shown) that forms an image of the observation target portion facing the distal end surface 102a is provided, and in the insertion tube 100, the observation target portion from the distal end surface 102a is provided. By operating the operation unit 101, an unillustrated light fiber comprising an optical fiber bundle for guiding illumination light for illuminating the image, an unillustrated image fiber comprising an optical fiber bundle for transmitting an image of the observation target portion by the objective lens, and the operation unit 101 An operating mechanism (not shown) such as an operation wire for bending the bending portion 103 is accommodated.

  When this medical endoscope apparatus Sa is used, the flexible portion 104 of the insertion tube 100 is appropriately bent, and the insertion tube 100 is inserted into the body cavity of the subject from the tip thereof, as shown in FIG. Further, the bending portion 103 is appropriately bent and deformed by operating the operation lever of the operation portion 101, the distal end surface 102a is opposed to the observation target portion, the observation target portion is imaged, and observed through an external monitor ( For example, refer to JP 2005-124632 A).

JP 2005-124632 A

  By the way, in the above-mentioned conventional medical endoscope apparatus Sa, for example, in the cranial nerve disease region, this is supported by hydrocephalic ventricular opening, intraventricular tumor extraction, craniotomy cerebral aneurysm clipping, pituitary gland When the surgeon inserts the distal end portion 102 of the insertion tube 100 into a predetermined place in the brain, the tissue in the brain is extremely affected by damage. There is a fact that it is extremely difficult to insert without damaging the place and surrounding tissue even if it is skilled. For example, as shown in FIG. 5B, the clipping state of the surface of the blood vessel K that is difficult to observe in cerebral aneurysm surgery (such as target blood flow stop and blood flow resumption) is confirmed by ICG fluorescence angiography. In this case, in this conventional medical endoscope apparatus Sa, although the flexible portion 104 of the insertion tube 100 can be appropriately bent and adjusted, the bending portion 103 is bent by the operation portion 101. This is because an operating mechanism must be provided, so that the bending portion 103 is thicker, and there is a concern that the brain tissue may be damaged during the operation. Also, even if the bending portion 103 is bent in advance by the operation portion and then the insertion tube 100 is inserted, since the bending portion 103 is relatively thick, the curvature radius of the bending portion 103 is limited, Moreover, since the radius of curvature is relatively large and the bending angle is 180 ° at most, it is difficult to insert, and the distal end surface 102a of the insertion tube 100 cannot be accurately opposed to the observation target portion. . In particular, it is extremely difficult to observe the back side of the blood vessel K in the brain, which is difficult to see with the naked eye from the craniotomy site.

  The present invention has been made in view of such problems, and can bend the curved portion manually in advance, and bend as compactly as possible, and damage the tissue of the subject during insertion. An object of the present invention is to provide a medical endoscope apparatus in which the distal end surface of the insertion tube can be accurately opposed to the observation target portion.

In order to achieve such an object, the medical endoscope apparatus of the present invention has an insertion tube that can be inserted into a subject, and has a distal end surface on which the insertion tube is formed as an observation window of an observation target portion. In a medical endoscope apparatus comprising: a distal end portion having a bending portion connected to the proximal end side of the distal end portion; and a flexible portion connected to the proximal end side of the bending portion.
The bending portion of the insertion tube is configured so as to be bent manually and held in a bent state, and is formed so as to be inserted into a subject, and the insertion tube is inserted so as to be able to advance and retract, and to advance and retract. A guide tube having a tube main body from which all or part of the curved portion of the insertion tube can protrude from the tip is provided, and the tube main body of the guide tube can be bent manually and held in a bent state. It is composed.

  Thus, when using this medical endoscope apparatus to observe the observation target portion in the subject, the insertion tube is inserted into the guide tube, and the distal end portion of the insertion tube and the curved portion are inserted from the distal end of the guide tube. Protruding the part appropriately and adjusting the protruding length. Then, the bending portion is manually bent in advance so as to match the position of the observation site. Further, the guide tube is also appropriately bent by hand so that it can be inserted along the insertion path. In this case, in bending the bending portion, the bending portion can be bent manually, and the shape is held in a bent state. Can be formed relatively thin. Moreover, since the insertion tube is inserted into the guide tube so as to be able to advance and retract, the protruding lengths of the distal end portion and the bending portion of the insertion tube can be adjusted. Therefore, for example, it can be formed so that it can be easily bent so that the direction of the distal end surface can be reversed 180 degrees or more when the insertion tube is linearly extended, and the radius of curvature is reduced even if it is bent. Therefore, the curved portions can be collected as compactly as possible. For this reason, the direction of the tip surface can be made appropriate by adjusting the bending of the bending portion, and the size of the bending portion in the bent state can be made appropriate.

In this state, the guide tube is grasped, and the distal end portion and the curved portion of the insertion tube protruding from the distal end of the guide tube are inserted into the tissue of the subject. In this case, since the bending portion of the insertion tube is bent in a compact manner, it is easy to insert the distal end portion and the bending portion of the insertion tube into the subject, and the guide tube also follows the insertion path. Therefore, the insertion can be performed very easily. Therefore, the distal end surface of the insertion tube can be accurately opposed to the observation target portion without damaging the tissue of the subject.
In particular, for example, when attempting to observe the back side of a tissue that is difficult to see with the naked eye from the craniotomy site in the skull, specifically, for example, the clipping status of the surface observation difficult part in cerebral aneurysm surgery (target blood flow) It is extremely effective when confirming stop, resumption of blood flow, etc.) by ICG fluorescence angiography.

  If necessary, the bending rigidity of the bending portion of the insertion tube is made smaller than the bending rigidity of the tube main body of the guide tube. For example, the bending portion is formed to be bendable so that the direction of the distal end surface when the insertion tube is linearly extended can be reversed by 180 degrees or more. As a result, the bending portion of the insertion tube can be easily bent so that the distal end surface can be reliably opposed to the observation site and the rigidity of the guide tube is increased. The guide tube can be easily inserted, and the flexible portion of the insertion tube can be prevented from being deformed and held in a desired shape.

  If necessary, the length La of the bending portion is set to 10 mm ≦ La ≦ 50 mm, and the diameter Da of the bending portion of the insertion tube is set to 0.3 mm ≦ Da ≦ 3.0 mm. . In addition, the curved portion has a value of Da that is as small and thin as possible, but considering the strength and the like, it can be set to 0.7 mm ≦ Da. For example, 20 mm ≦ La ≦ 40 mm and 1.5 mm ≦ Da ≦ 2.5 mm can be set. As a result, the bending portion can be reliably bent in a compact manner.

Further, if necessary, the inner diameter Db of the tube body of the guide tube is set to 1.1 mm ≦ Db ≦ 3.1 mm, and the outer diameter Dc of the tube body of the guide tube is set to 1.5 mm ≦ Dc ≦ 3. The configuration is set to 5 mm. Desirably, 1.6 mm ≦ Db ≦ 2.6 mm and 2.0 mm ≦ Dc ≦ 3.0 mm. Thereby, the insertion of the insertion tube into the tube body can be facilitated, and the insertion of the guide tube into the subject can be performed easily and reliably.
In this case, it is effective to set 0.1 mm ≦ (Db−Da) ≦ 0.4 mm. Thereby, the clearance between the curved portion of the insertion tube and the guide tube can be optimized. The larger the clearance, the smoother the movement of the insertion tube, but there is no backlash or position. If the clearance is too small, the mobility of the insertion tube will deteriorate.

  Further, if necessary, a positioning lock mechanism for positioning and locking the insertion tube at a desired forward / backward movement position with respect to the guide tube is provided. Even if there is no positioning lock mechanism, the insertion tube can be held by frictional resistance between the insertion tube and the guide or by bending of the curved portion, but since the positioning lock mechanism is provided, the insertion tube can be held against the guide tube. It can be done reliably.

  In this case, if necessary, the guide tube is configured to include a support tube that supports the proximal end portion of the tube body, and the support tube that supports the insertion tube is supported on the proximal end portion of the flexible portion of the insertion tube. A member is provided, and the positioning lock mechanism protrudes from the support member toward the insertion tube, and is fitted to the support tube of the guide tube when the insertion tube is inserted, and supports the fitting tube Fastening means for releasably fastening to the tube is provided. Accordingly, when the insertion tube is inserted into the guide tube and the protruding lengths of the distal end portion and the bending portion are adjusted, the fitted tube fits the support tube of the guide tube. Then, the fitting tube is fixed to the support tube by the fixing means of the lock mechanism. The insertion tube can be positioned on the guide tube with a simple structure.

  Further, if necessary, the fastening means is screwed into the female screw with a female thread portion formed on the fitted pipe and having an axis perpendicular to the axial direction of the fitted pipe. And a bolt having a male thread portion that abuts the support tube and restricts the movement of the fitting tube. Since the fastening means is configured with a bolt, the structure is simple and the operability is improved.

  Furthermore, if necessary, an objective lens that forms an image of the observation target portion is provided in the distal end portion of the insertion tube, and light that guides illumination light that illuminates the observation target portion through the distal end surface in the insertion tube. A configuration in which a light fiber made of a fiber bundle, an image fiber by an optical fiber bundle that transmits an image of an observation target portion by the objective lens, and a shape holding wire that can be bent and hold the shape of the curved portion in a bent state It can be. Since it is not necessary to provide the operation mechanism by an operation part like the past, it can be formed comparatively thinly and can be simplified further. Therefore, the bending portion can be easily bent, for example, the direction of the distal end surface when the insertion tube is linearly extended can be reversed by 180 degrees or more, and the bending portion can be bent. Since the radius of curvature can be reduced, the tip can be compactly arranged by positioning the tip as close as possible to the tip of the guide tube.

  Further, if necessary, the guide tube includes a support tube that supports the proximal end portion of the tube body, and the support tube is configured by a medical suction device formed as a connection portion connected to a suction hose. Yes. Since an existing medical suction device is used as a guide tube, versatility can be improved. In particular, when a lock mechanism having a configuration with a fitting tube fitted to a support tube of the guide tube when the insertion tube is inserted into the guide tube, the lock mechanism is used as an existing medical suction device. Therefore, the medical suction device can be used as it is, and the versatility can be further improved.

  According to the present invention, the bending portion can be bent manually in advance, and can be bent as compactly as possible. Therefore, the distal end portion of the insertion tube protruding from the distal end of the guide tube while operating the guide tube. When the curved portion is inserted into the subject tissue, the distal end surface of the insertion tube can be accurately opposed to the observation target portion without damaging the subject tissue.

1 is a perspective view showing a medical endoscope apparatus according to an embodiment of the present invention. 1 is an exploded side view showing a medical endoscope apparatus according to an embodiment of the present invention. The insertion tube of the medical endoscope apparatus which concerns on embodiment of this invention is shown, (a) is side surface sectional drawing which shows the structure of the front-end | tip part and bending part of an insertion tube, (b) is A- in (a). It is A sectional view. It is principal part sectional drawing which shows the locking mechanism of the medical endoscope apparatus which concerns on embodiment of this invention. It is a figure which shows the use condition of the medical endoscope apparatus which concerns on embodiment of this invention compared with the use condition of the conventional medical endoscope apparatus, (a) concerns on embodiment of this invention The principal part figure which shows the use condition of a medical endoscope apparatus, (b) is a principal part figure which shows the use condition of the conventional medical endoscope apparatus. It is a perspective view which shows an example of the conventional medical endoscope apparatus.

Hereinafter, a medical endoscope apparatus according to an embodiment of the present invention will be described in detail with reference to the accompanying drawings.
1 to 4 show a medical endoscope apparatus S according to an embodiment of the present invention. This medical endoscope apparatus S includes an insertion tube 1 that can be inserted into a subject. The insertion tube 1 includes a hard distal end portion 2 having a distal end surface 2 a formed as an observation window of the observation target portion, a bending portion 3 connected to the proximal end side of the distal end portion 2, and a proximal end side of the bending portion 3. And a flexible portion 4 connected to the. A support member 5 that is tubular and supports the insertion tube 1 and has a diameter larger than that of the insertion tube 1 is provided at the proximal end portion of the flexible portion 4 of the insertion tube 1. In particular, the bending portion 3 of the insertion tube 1 is configured to be bent manually and to retain its shape in a bent state.

  Specifically, as shown in FIGS. 2 and 3, the distal end portion 2 is provided with an outer cylinder 10 made of, for example, stainless steel, and a window member 11 made of, for example, polycarbonate is fitted to the distal end thereof. The front end surface 2a of the window member 11 constitutes an observation window. Further, in the distal end portion 2, for example, a first inner cylinder 12 made of stainless steel, which is smaller in diameter than the outer cylinder 10 and whose axis is parallel and eccentric to the axis of the outer cylinder 10 is provided. A pair of objective lenses 13 are provided on the distal end side of the first inner cylinder 12 so as to be spaced apart at a predetermined interval and form an image of the observation target portion. Further, inside the outer cylinder 10 and outside the first inner cylinder 12 is an optical fiber bundle that guides illumination light whose end face is in contact with the window member 11 and illuminates the observation target portion through the distal end surface 2a of the window member 11. A light fiber 14 is accommodated. For example, the light fiber 14 may be a well-bendable plastic optical fiber made of polymethyl methacrylate, fluororesin, polycarbonate, polystyrene, or a glass optical fiber such as quartz glass or multicomponent glass. A glass optical fiber bundle (for example, an image guide made by Sumita Optical Glass) or the like bundled in a simple structure is used. The light fiber 14 is concentrated and extended to the outside through the insertion tube 1 and the support member 5, and an adapter 15 (FIG. 2) connected to a light source unit (not shown) that supplies a light source at the base end thereof. ) Is provided. The external light fiber 14 is covered with, for example, a silicone tube.

  Further, in the distal end portion 2, for example, a second inner cylinder 16 made of stainless steel is fitted into the first inner cylinder 12 continuously to the objective lens 13 on the proximal end side at the proximal end side of the first inner cylinder 12. Are connected. The second inner cylinder 16 accommodates an image fiber 17 formed of an optical fiber bundle whose end surface is in contact with the objective lens 13 on the proximal end side and transmits an image of an observation target portion by the objective lens 13. As the image fiber 17, for example, a well-bendable plastic optical fiber made of polymethyl methacrylate, fluororesin, polycarbonate, polystyrene, or the like, or a glass optical fiber such as quartz glass or multi-component glass is easily bent. A glass optical fiber bundle (for example, an image guide made by Sumita Optical Glass) or the like bundled in a simple structure is used. The image fiber 17 is gathered and extended to the outside through the insertion tube 1 and the support member 5, and an adapter connected to a camera unit (not shown) that performs image processing and displays it on the monitor at its base end. 18 (FIG. 2) is provided. The external light fiber 14 is covered with, for example, a silicone tube.

  Also, in the insertion tube 1 and in the light fiber 14, a shape holding wire 20 is housed that can be bent and holds the shape of the bending portion 3 in a bent state from the window member 11 to the support member 5. . The shape retaining wire 20 is made of SUS302, SUS304, SUS316, nickel titanium alloy such as nitinol, titanium, titanium alloy, cobalt alloy (cobalt chromium molybdenum, cobalt chrome tungsten, cobalt nickel chrome molybdenum, etc.), platinum alloy, tungsten alloy, molybdenum alloy. A material made of a metal material such as the above is suitable, but may also be made of a polyurethane-based polymer. The thickness of the shape retaining wire 20 is preferably 0.05 mm to 1.2 mm. In the embodiment, it is set to 0.1 mm. Further, although one shape holding wire 20 is used in the embodiment, the shape holding wire 20 is not necessarily limited to this, and a plurality of shape holding wires 20 may be provided.

  The light fiber 14 and the shape holding wire 20 are bound to the second inner cylinder 16 by a plurality of gussets 21. In addition, without using the Tegs 21, it may be bonded and bonded by an adhesive or may be bonded by welding, and may be changed as appropriate. Further, the light fiber 14 is covered with a flexible thin silicon resin film 22, and the light fiber 14 between the outer cylinder 10 and the support member 5 has the same outer diameter as the outer cylinder 10. Covered with a flexible thin silicon resin tube 23. Thereby, the front-end | tip part 2 is comprised from the front end surface 2a to the rear-end surface 16a of the 2nd inner cylinder 16, and the bending part 3 and the flexible part 4 are between the front-end | tip part 2 and the supporting member 5, , Made of the same material. In the embodiment, the boundary E between the bending portion 3 and the flexible portion 4 is determined at the position of the distal end 30a of the guide tube 30 when the insertion portion protrudes from the distal end of the guide tube 30 described later to the maximum. Then, the bending portion 3 can be bent manually and can be held in a bent state by the bending rigidity of the image fiber 17, the light fiber 14, the shape holding wire 20, the thin silicon resin film 22 and the thin silicon resin tube 23. It is configured. For example, the bending portion 3 is formed to be bendable so that the direction of the distal end surface 2a when the insertion tube 1 is extended in a straight line can be reversed by 180 degrees or more.

  In addition, the length L of the insertion tube 1 is set to 200 m ≦ L ≦ 300 mm in the embodiment. In the embodiment, L = 240 mm is set. The length La of the bending portion 3 is set to 10 mm ≦ La ≦ 50 mm, and preferably 20 mm ≦ La ≦ 40 mm. In the embodiment, it is set to 30 mm. Further, the length Lb of the distal end portion 2 is set to 3 mm ≦ Lb ≦ 10 mm. In the embodiment, Lb = 7 mm. Moreover, the diameter Da of the curved portion 3 of the insertion tube 1 is set to 0.3 mm ≦ Da ≦ 3.0 mm. The bending portion has a value of Da that is as small and thin as possible, but it can be set to 0.7 mm ≦ Da in consideration of strength and the like. Desirably, it is set as 1.5 mm <= Da <= 2.5mm. In the embodiment, Da is set to 1.9 mm. Further, in the embodiment, the diameter of the insertion tube 1 is set to be uniform, that is, the distal end portion 2 and the flexible portion 4 have the same diameter as the diameter Da of the bending portion 3.

  The medical endoscope apparatus S according to the embodiment includes a guide tube 30. The guide tube 30 is formed so that it can be inserted into a subject, and the insertion tube 1 is inserted so as to be able to advance and retreat, so that the entire or a part of the bending portion 3 of the insertion tube 1 can protrude from the distal end. A main body 31 and a support pipe 32 that supports the proximal end portion of the pipe main body 31 are provided. As shown in FIG. 4, when the insertion tube 1 is inserted into the guide tube 30, the distal end-side large diameter portion 5 a of the support member 5 of the insertion tube 1 contacts the proximal end 32 a of the support tube 32 of the guide tube 30. Touch. As described above, the boundary E between the bending portion 3 and the flexible portion 4 is determined at the position of the distal end 30a of the guide tube 30 when the insertion tube 1 protrudes from the distal end 30a of the guide tube 30 to the maximum in the embodiment. Therefore, in the embodiment, the entire bending portion 3 of the insertion tube 1 can protrude from the tube body 31. The tube main body 31 of the guide tube 30 is configured to be bent manually and to hold the shape in a bent state. The bending rigidity of the tube body 31 of the guide tube 30 is larger than the bending rigidity of the bending portion 3 of the insertion tube 1. In the embodiment, the proximal end portion 33 of the guide tube 30 is composed of a commercially available medical suction device formed as a so-called bamboo stalk-like connection portion in which the support tube 32 is connected to a suction hose (not shown). Yes.

The inner diameter Db of the tube main body 31 of the guide tube 30 is set to 1.1 mm ≦ Db ≦ 3.1 mm, and the outer diameter Dc of the tube main body 31 of the guide tube 30 is set to 1.5 mm ≦ Dc ≦ 3.5 mm. Has been. Desirably, 1.6 mm ≦ Db ≦ 2.6 mm and 2.0 mm ≦ Dc ≦ 3.0 mm. In the embodiment, Db = 2.2 mm and Dc = 2.6 mm are set.
In this guide tube 30, it is effective to set 0.1 mm ≦ (Db−Da) ≦ 0.4 mm. In the embodiment, (Db−Da) = 2.2 mm−1.9 mm = 0.3 mm. Thereby, the clearance between the bending portion 3 of the insertion tube 1 and the guide tube 30 can be optimized. The larger the clearance, the smoother the movement of the insertion tube 1 is, however, the backlash occurs and the position is not fixed. If the clearance is too small, the mobility of the insertion tube 1 is deteriorated.
Thereby, the insertion of the insertion tube 1 into the tube main body 31 can be facilitated, and the insertion of the guide tube 30 into the subject can be performed easily and reliably.

  Further, the medical endoscope apparatus S according to the embodiment is provided with a positioning lock mechanism 40 that positions and locks the insertion tube 1 at a desired advance / retreat position with respect to the guide tube 30. As shown in FIG. 4, the positioning lock mechanism 40 includes a fitting tube 41 that protrudes from the support member 5 toward the insertion tube 1 and is fitted on the support tube 32 of the guide tube 30 when the insertion tube 1 is inserted. Fastening means 42 for fastening the fitting pipe 41 to the support pipe 32 so as to be releasable is provided. The fastening means 42 includes a female screw portion 43 formed on the fitting tube 41 and having an axis orthogonal to the axial direction of the fitting tube 41, and a proximal end of the guide tube 30 by screwing into the female screw portion 43 and tightening. And a bolt 44 having a male threaded portion 44 a that abuts on the portion 33 and restricts the movement of the fitting tube 41. In this case, the positioning lock mechanism 40 includes a fitting tube 41 that is fitted to the support tube 32 of the guide tube 30 when the insertion tube 1 is inserted into the guide tube 30, and the fitting tube 41 is fixed to the support tube 32. Since the positioning lock mechanism 40 does not have to be separately provided in the guide tube 30 that is an existing medical suction device, the medical suction device can be used as it is, and the versatility can be improved accordingly. it can.

  Therefore, when using the medical endoscope apparatus S according to the embodiment to observe the observation target portion in the subject, for example, the back side of the tissue that is difficult to see with the naked eye from the craniotomy site in the skull is used. When observing, specifically, for example, as shown in FIG. 5 (a), the clipping state of the surface observation difficult part of the blood vessel K in the cerebral aneurysm surgery (target stop of blood flow, resumption of blood flow, etc.) ) In the case of confirmation by ICG fluorescence angiography is as follows.

  As shown in FIG. 1, first, the insertion tube 1 is inserted into the guide tube 30, and the distal end portion 2 and the curved portion 3 of the insertion tube 1 are appropriately projected from the distal end 30 a of the guide tube 30 to adjust the projection length. Then, the fitting tube 41 is fixed to the support tube 32 by the fixing means 42 of the positioning lock mechanism 40. That is, as shown in FIG. 4, the fitted tube 41 is fitted with the support tube 32 of the guide tube 30, and when the bolt 44 of the fastening means 42 is tightened, the male thread portion 44 a of the bolt 44 is connected to the guide tube 30. The movement of the fitting tube 41 is restricted by contacting the support tube 32. The insertion tube 1 can be positioned on the guide tube 30 with a simple structure. Further, since the positioning lock mechanism 40 is provided, the insertion tube 1 can be reliably held with respect to the guide tube 30.

  Next, as shown in FIG. 1, the bending portion 3 is manually bent in advance so as to match the position of the observation site. Further, the guide tube 30 is also appropriately bent by hand so that it can be inserted along the insertion path. In this case, in bending of the bending portion 3, the bending portion 3 is formed thin (Da = 1.9 mm in the embodiment), and the direction of the distal end surface 2a when the insertion tube 1 extends linearly Is formed so that it can be bent more than 180 degrees, and the protruding lengths of the distal end portion 2 and the bending portion 3 of the insertion tube 1 are adjusted, so that the radius of curvature is reduced even when bent. The bending portion 3 can be collected as compact as possible. For this reason, the direction of the distal end surface 2a can be made appropriate by adjusting the bending of the bending portion 3, and the size of the bending portion 3 in the bent state can be made appropriate.

  In this state, the guide tube 30 is grasped, and the distal end portion 2 and the bending portion 3 of the insertion tube 1 protruding from the distal end of the guide tube 30 are inserted into the tissue of the subject. In this case, as shown in FIG. 5A, the bending portion 3 of the insertion tube 1 is bent in a compact manner, so that the distal end portion 2 and the bending portion 3 of the insertion tube 1 can be easily inserted into the subject. In addition, since the guide tube 30 is also appropriately curved by hand so that it can be inserted along the insertion path, the insertion can be performed very easily. Furthermore, since the bending rigidity of the tube main body 31 of the guide tube 30 is larger than the bending rigidity of the bending portion 3 of the insertion tube 1, the guide tube 30 can be securely held and the guide tube 30 can be easily inserted. In addition, deformation of the flexible portion 4 of the insertion tube 1 can be prevented and held in a desired shape. Therefore, the distal end surface 2a of the insertion tube 1 can be accurately opposed to the observation target portion without damaging the tissue of the subject. In particular, as shown in FIG. 5 (a), the clipping status of the surface of the blood vessel K that is difficult to observe in cerebral aneurysm surgery (such as target blood flow stop and blood flow resumption) should be confirmed by ICG fluorescence angiography. If so, it will be extremely effective.

  Moreover, since the guide tube 30 is a medical suction device, it can be used for normal use if the insertion tube 1 is pulled out. That is, an aspiration hose is connected to the proximal end portion 33 of the support tube 32, inserted into the subject, and blood, body fluid, secretion fluid, bone fragments, etc. are aspirated and discharged from the subject.

  In the above embodiment, the configuration and dimensions of the insertion tube and the guide tube are not limited to those described above, and may be changed as appropriate. In the embodiment, the observation in the brain has been described. However, the present invention is not limited to this, and is used in various medical fields other than the cranial nerve disease area such as an intraperitoneal examination and surgical support in the digestive disease area. Of course it is good.

DESCRIPTION OF SYMBOLS S Endoscope apparatus K Blood vessel 1 Insertion tube 2 Tip part 2a Tip surface 3 Curved part 4 Flexible part 5 Support member 10 Outer cylinder 11 Window member 12 First inner cylinder 13 Objective lens 14 Light fiber 16 Second inner cylinder 17 Image fiber 20 Shape holding wire 23 Thin-walled silicone resin tube E Boundary 30 Guide tube 30a Tip 31 Tube body 32 Support tube 33 Base end 40 Positioning lock mechanism 41 Fit tube 42 Fastening means

Claims (10)

An insertion tube that can be inserted into a subject; a distal end portion having a distal end surface formed as an observation window of the observation target portion; and a curved portion connected to a proximal end side of the distal end portion; In the medical endoscope apparatus configured to include a flexible portion connected to the proximal end side of the bending portion,
The bending portion of the insertion tube is configured to be bent manually and to be held in a bent state,
A guide tube having a tube body that is formed so as to be insertable into a subject and that allows the insertion tube to be advanced and retracted so that all or part of the curved portion of the insertion tube can protrude from the distal end. And a tube body of the guide tube is configured to be bent manually and to be held in a bent state.   The medical endoscope apparatus according to claim 1, wherein the bending rigidity of the bending portion of the insertion tube is smaller than the bending rigidity of the tube main body of the guide tube.   The length La of the bending portion is set to 10 mm ≦ La ≦ 50 mm, and the diameter Da of the bending portion of the insertion tube is set to 0.3 mm ≦ Da ≦ 3.0 mm. 2. The medical endoscope apparatus according to 2.   The inner diameter Db of the tube body of the guide tube is set to 1.1 mm ≦ Db ≦ 3.1 mm, and the outer diameter Dc of the tube body of the guide tube is set to 1.5 mm ≦ Dc ≦ 3.5 mm. The medical endoscope apparatus according to claim 3, wherein:   The medical endoscope apparatus according to claim 4, wherein 0.1 mm ≦ (Db−Da) ≦ 0.4 mm is set.   6. The medical endoscope apparatus according to claim 1, further comprising a positioning lock mechanism that positions and locks the insertion tube at a desired forward / backward movement position with respect to the guide tube. The guide tube is configured with a support tube that supports the proximal end of the tube body,
A support member that supports the insertion tube is provided at a proximal end portion of the flexible portion of the insertion tube, and the positioning lock mechanism protrudes from the support member toward the insertion tube, and the guide is inserted when the insertion tube is inserted. 7. A medical internal device according to claim 6, comprising: a fitting tube fitted to a support tube of the tube; and a fastening means for releasably fastening the fitting tube to the support tube. Endoscopic device.   The fastening means includes a female screw portion formed on the fitting tube and having an axis perpendicular to the axial direction of the fitting tube, and is screwed into the female screw and brought into contact with the support tube of the guide tube by tightening. The medical endoscope apparatus according to claim 7, further comprising a bolt having a male screw portion that restricts movement of the fitting tube.   A light fiber comprising an optical fiber bundle that includes an objective lens that forms an image of the observation target portion in the distal end portion of the insertion tube and guides illumination light that illuminates the observation target portion through the distal end surface in the insertion tube. And an image fiber formed by an optical fiber bundle that transmits an image of an observation target portion by the objective lens, and a shape holding wire that is bendable and holds the shape of the curved portion in a bent state. The medical endoscope apparatus according to any one of 1 to 8.   The said guide tube is provided with the support tube which supports the base end part of the said tube main body, Comprising: This support tube was comprised with the medical suction device formed as a connection part connected to a suction hose. The medical endoscope apparatus according to any one of 1 to 9.

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