JP2993355B2 - Treatment instrument insertion passage for in-vivo examination device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an in-vivo inspection apparatus, such as an endoscope or an ultrasonic inspection apparatus, in which inspection means is attached to a distal end of an insertion portion to be inserted into a body cavity. The present invention relates to a treatment tool insertion passage through which a treatment tool is inserted.

[0002]

2. Description of the Related Art An in-vivo inspection apparatus such as an endoscope, an ultrasonic inspection apparatus, or an ultrasonic endoscope provided with an inspection mechanism of an endoscope and an inspection mechanism of an ultrasonic inspection apparatus is used by an operator. An insertion section into the body cavity is connected to the main body operation section that performs gripping and operation, and the main body operation section includes a light source device, a processor, and a universal cord that is detachably connected to an ultrasonic observation device. It has a configuration. For example, in an ultrasonic endoscope, a distal end hard portion is provided at the distal end of the insertion section, and an endoscope observation mechanism and an ultrasonic observation mechanism are mounted on the distal end hard portion.
Usually, it is more advantageous to take an observation field of view with an endoscope forward for an insertion operation or the like. Since the space of the distal end surface of the hard distal end portion is limited, the ultrasonic observation mechanism is generally mounted on the side surface of the hard distal end portion.

[0003] The observation mechanism of the endoscope includes an illumination system for illuminating the inside of the body via a light guide, an objective lens, and a solid-state image pickup device (an image guide in the case of an optical system) provided at an imaging position of the objective lens. ) And an observation system comprising: An ultrasonic transducer is provided as an ultrasonic observation mechanism.

[0004] When an affected part or the like is found by observing the inside of the body with an endoscope observation mechanism, a treatment tool such as a forceps or an electric scalpel is used to treat the affected part or to sample cells. Such a treatment instrument is operated under monitoring of an endoscope observation mechanism. In addition, since the ultrasonic observation mechanism can acquire information on the tissue state in the body, if there is an affected part in the body tissue, a puncture device is used to inject an injection solution or perform drainage. The operation of puncturing the puncture device into the body is performed under monitoring by an ultrasonic observation mechanism.

[0005]

As described above, there are a treatment tool operated under the monitoring of the endoscope observation mechanism and a treatment tool operated under the monitoring of the ultrasonic observation mechanism. The guide is guided along a treatment instrument insertion passage provided in the insertion portion. By the way, as already described, if the endoscope observation mechanism is provided on the distal end surface of the insertion portion and the ultrasonic observation mechanism is provided on the side surface of the distal end portion of the insertion portion, monitoring of the endoscope observation mechanism The treatment tool operated below must be led out from the distal end surface of the insertion section, and the treatment tool operated under monitoring by the ultrasonic observation mechanism needs to be led out from the side surface of the insertion section. In other words, two treatment tool insertion passages must be provided. However, if two treatment tool insertion passages are provided in this way, the diameter of the insertion portion becomes large. The insertion part is
It is inserted into the patient's body, and since this insertion path has stenosis and the like, if the insertion part is made large in diameter, not only will the patient be distressed, but the insertion operability will be poor, and if it is severe, Insertion may not be possible. Also, if the diameter of the insertion portion is forcibly reduced, the filling rate in the insertion portion increases. Here, the treatment tool insertion passage is formed of a flexible tube in the flexible portion and the angle portion of the insertion portion, and in addition to the treatment tool insertion passage, at least an ultrafine optical fiber is bundled in order to transmit illumination light. Light guides and other members are inserted, and especially when the angle portion is bent, these insertion members will press against each other, which may cause damage such as buckling, kink, disconnection of the optical fiber, etc. There is.

The present invention has been made in view of the above points, and an object of the present invention is to allow a treatment tool to be moved from a distal end surface of a rigid distal end portion without increasing the diameter of an insertion portion.
Another object is to make it possible to derive from the side.

[0007]

In order to achieve the above-mentioned object, according to the present invention, an inspection means is mounted at the tip of an insertion portion into a body cavity, and a treatment tool is provided in the insertion portion in the axial direction thereof. An insertion passage is provided, the treatment tool insertion passage is opened at the distal end surface of the insertion portion, one end of a branch passage is connected to the treatment tool insertion passage, and the other end of the branch passage is opened at a side surface of the insertion portion. The treatment instrument guide member for guiding the treatment instrument in the direction of the branch passage is detachably attached to the connecting portion of the treatment instrument insertion passage to the branch passage. is there.

[0008]

The treatment instrument insertion passage is formed in the insertion section so as to extend straight in the axial direction thereof, so that if the treatment instrument is inserted as it is, it will be drawn out from the opening at the distal end surface of the insertion section. Therefore, the inspection mechanism,
For example, when an endoscope observation mechanism is provided, a treatment or the like can be performed using a treatment tool operated under monitoring of the endoscope observation mechanism. On the other hand, when the treatment tool guide member is attached to the connection portion of the treatment tool insertion passage with the branch passage, the treatment tool inserted into the treatment tool insertion passage is guided by the treatment tool guide member and shifts to the branch passage side. Then, it is led out from the opening formed on the side surface of the insertion portion. Here, if another inspection mechanism, for example, an ultrasonic observation mechanism is provided on the side surface of the insertion portion, a treatment or the like can be performed using a treatment tool operated under monitoring by the ultrasonic observation mechanism.

As described above, a single passage is formed inside the insertion portion and the passage is branched at the distal end portion, so that a single treatment instrument insertion passage may be provided inside the insertion portion. Therefore, the diameter can be reduced, and the space for the insertion portion can be given a margin.
When the insertion part is bent, etc., damages such as buckling or kink occurring due to compression between the built-in objects and breakage of the ultra-fine and fragile optical fiber constituting the light guide, etc. Can be prevented.

[0010]

Embodiments of the present invention will be described below with reference to the drawings. First, FIG. 1 shows an overall configuration of an ultrasonic endoscope, and FIG. 2 shows a cross section of a distal end portion thereof. In the figure,
Reference numeral 1 denotes an insertion portion, 2 denotes a main body operation portion, and 3 denotes a universal cord. The insertion portion 1 is a flexible portion which is bent along the insertion path from the portion connected to the main body operation portion 2 for the most part. An angle portion 5 that can be bent in a desired direction by a hand operation is provided at a distal end portion of the flexible portion 4, and a hard distal end portion 6 is sequentially provided at the distal end of the angle portion 5.

As shown in FIG. 3, an endoscope observation means having an illumination window 10 and an observation window 11 is provided on the distal end surface 6a of the distal end hard portion 6. The illumination light exit end of the light guide faces the illumination window 10, and the observation window 11 is provided with an objective lens, and a solid-state image sensor as imaging means is provided at an image forming position of the objective lens. An endoscope observation image is converted into an electric signal by a solid-state imaging device and extracted. Further, an ultrasonic transducer 12 is mounted on a side surface position of the distal end hard portion 6.
The ultrasonic transducer 12 is configured by arranging a large number of ultrasonic transducers in the axial direction of the distal end hard portion 6 so that electronic scanning can be performed.

Under illumination of illumination light from the illumination window 10 and monitoring by an endoscope observation mechanism obtained through the observation window 11, forceps and other treatment tools can be used. Under the monitoring by the ultrasonic observation mechanism obtained by the above, a treatment tool such as a puncture tool that performs a treatment by piercing the body can be used. As a typical example of the endoscope treatment tool 13 used under monitoring of the endoscope observation mechanism, there is a forceps as shown in FIG. And a pair of gripping claws 13a, which are attached to the mounting member 13b so as to be openable and closable. And this gripping claw 13
In order to remotely open and close a, a flexible control cable 13c having an operation wire inserted therein is connected to the mounting member 13b. Also, a typical example of the ultrasonic treatment tool 14 used under the monitoring of the ultrasonic observation mechanism is a puncture tool for pumping an injection solution,
As shown in FIG. 5, a puncture needle 14b is inserted into a flexible outer tube 14a, and a liquid feed tube 14c is connected to the puncture needle 14b.

A treatment tool insertion passage 20 for inserting a treatment tool is provided inside the insertion section 1. The treatment instrument insertion passage 20 is formed of a single flexible tube 21 in the flexible portion 4 and the angle portion 5 of the insertion portion 1, and the distal end of the flexible tube 21 is connected to the branch tube 22. I have. The branch pipe 2 is provided in the distal end hard portion 6.
2, a straight insertion passage 23 leading to the straight portion 22a and a branch insertion passage 24 branching from the middle of the straight portion 22a and leading to a branch portion 22b directed in the side direction. Therefore, the straight insertion passage 23 is formed by the distal end face 6 of the distal end hard portion 6.
a, a first treatment tool outlet 23a for leading out the endoscope treatment tool 13 is formed.
4 rises so as to be curved from the branch portion 22b,
Ultrasonic transducer 1 on the side of tip rigid portion 6
The second treatment tool outlet 24a for opening the ultrasonic treatment tool 14 is opened at a position closer to the near side than the mounting position of the second treatment tool 2.

Further, reference numeral 30 denotes a treatment tool guide member, and this treatment tool guide member 30
Is for guiding the ultrasonic treatment instrument 14 toward the branch insertion passage 24 when the is inserted into the treatment instrument insertion passage 20. As is clear from FIG. 6, the treatment instrument guide member 30 includes a guide portion 31 and a screw portion 33 connected to the guide portion 31 via a rigid connecting rod 32. A screw groove is provided on the inner surface of the first treatment tool outlet 23a at the distal end of the rectilinear insertion passage 23, and the guide portion 31 of the treatment tool guide member 30 is inserted from the first treatment tool outlet 23a. Then, the screw part 33 is fixed by screwing it into the screw groove of the first treatment instrument outlet 23a. The guide portion 31 has a curved guide surface 31a connected to the inner wall of the branch insertion passage 24 for guiding the ultrasonic treatment instrument 14 in the branch insertion passage 24 direction. When the treatment tool guide member 30 is mounted, an arrow mark 34 indicating the direction is provided on the end surface of the screw portion 33 in order to adjust the position so that the guide surface 31a of the guide portion 31 is oriented in a predetermined direction.
Are drawn, and this arrow mark 34 is
When the position is adjusted to the position of the reference position mark 35 (see FIG. 3) formed on the distal end surface 6a, the branch portion is completely covered by the guide surface 31a, and the ultrasonic treatment tool 14 is guided to the branch insertion passage 24 side. Become so.

The present embodiment is configured as described above. In performing an examination inside the body using the ultrasonic endoscope, the inside of the body is observed by an endoscope observation mechanism. When performing treatment using the endoscope treatment tool 13,
The treatment tool guide member 30 is removed. As a result, the insertion section 1 is inserted into the body and guided to a site where a desired examination and treatment is to be performed. This operation is performed by the observation window 11 under illumination of illumination light performed through the illumination window 10. While doing. And, as shown in FIG.
The endoscope treatment tool 13 is fed from the flexible tube 21 constituting the treatment tool insertion passage 20 into the straight insertion passage 23 via the branch tube 22. The branch tube 22 includes a branch portion 22b. Since the branch portion 22b is angled so as to rise from the rectilinear portion 22a, the treatment tool 13 for an endoscope can be reliably connected to the rectilinear portion of the branch tube 22. Straight insertion passage 2 through 22a
3 and is led out from the first treatment tool lead-out port 23a, so that the endoscope treatment tool 13 can perform appropriate treatment such as excision of an affected part and collection of cells.

On the other hand, when the ultrasonic treatment instrument 14 is operated under the monitoring by the ultrasonic observation mechanism to perform treatment of the affected part or the like, the insertion operation of the insertion portion 1 into the body is performed by the endoscope observation mechanism. Under the observation by the endoscope observation mechanism, the ultrasonic transducer 12 provided on the side surface of the distal end hard portion 6 is guided to a site where ultrasonic observation is to be performed. Here, although not shown, in order to suppress the attenuation of the ultrasonic signal, a balloon is provided so as to cover the ultrasonic transducer 12, or the ultrasonic transducer 12 is in close contact with a body wall. Is operated to transmit the ultrasonic pulse toward the body and receive the reflected echo. Then, an ultrasonic image obtained by processing the thus-received reflected echo signal is displayed on the monitor device. When the affected part is found during the ultrasonic observation in this way, a treatment such as injecting an injection solution directly into the affected part is performed using the ultrasonic treatment tool 14.
For this purpose, an ultrasonic treatment instrument 14 is used.

When using the ultrasonic treatment instrument 14, the treatment instrument guide member 30 is mounted before the insertion section 1 of the ultrasonic endoscope is inserted into the body. The treatment tool guide member 30 is provided in the first straight passageway 23 from the guide portion 31 side.
Into the treatment instrument outlet 23a, and screw the screw portion 33 into the first
Is screwed into the treatment instrument outlet 23a, and the arrow mark 34 is driven until it matches the reference mark 35. As a result, the guide surface 31a of the guide portion 31 is inserted up to the branch portion between the straight portion 22a and the branch portion 22b in the branch pipe 22, so that the straight insertion passage 23 side in the straight portion 22a is closed and the branch portion 22b side is completely closed. It becomes a simple passage form.

As described above, when the treatment tool 14 is fed from the flexible tube 21 in the treatment tool insertion passage 20 into the branch pipe 22 with the treatment tool guide member 30 being mounted, the guide portion of the treatment tool guide member 30 en route. A second treatment tool outlet that rises along the guide surface 31a of the first guide member 31, is guided into the branch insertion passage 24, and opens to the base end side from the position where the ultrasonic transducer 12 is provided on the side surface of the hard distal end portion 6. The ultrasonic treatment instrument 14 can be punctured into the diseased part by being derived from 24a.

As described above, by using the treatment tool guide member 30, the treatment tool insertion passage 20 can be connected to the single distal end hard portion 6 only by attaching and detaching the treatment tool guide member 30. The flexible tube 21 is used for the treatment tool 1 for an endoscope.
3 and the ultrasonic treatment instrument 14 can be shared. That is, in the insertion portion 1, the treatment instrument insertion passage 20 is formed by a single passage inside the flexible portion 4 and the angle portion 5, and the filling rate of these portions can be suppressed low. In particular, the fact that the filling rate of the angle portion 5 that is curved at an extremely large angle such as 180 ° or more can be reduced is
The generation of compression between the internal components can be suppressed, the flexible tube 20 and the light guide can be protected, and the outer diameter of the insertion portion 1 can be reduced. In particular, the ultrasonic treatment instrument 14 must be led out from the side surface of the distal end hard portion 6 at a predetermined angle.
In the inside, since it is branched into the straight insertion passage 23 and the branch insertion passage 24, the direction of the ultrasonic treatment tool 14 drawn out from the second treatment tool outlet 24a can be accurately controlled, and The guide for the endoscope treatment tool 13 which is led out in a straight-forward state from the first treatment tool outlet 23a can also be smoothly performed.

In the above-described embodiment, the in-vivo inspection apparatus is configured as an ultrasonic endoscope. However, for example, as shown in FIG. 7, it may be configured as a direct-side-view type endoscope. it can. This direct-view-side-view type endoscope is configured such that an illumination window (not shown) and observation windows 52 and 53 are provided on the distal end surface and side surfaces of the distal end hard portion 51 in the insertion portion 50. The objective lenses 54,
55 is facing. Then, the objective lenses 54 and 55
Is a cemented prism 5 in which prisms 56a and 56b are joined.
6, and the optical paths from the objective lenses 54 and 55 are each bent by 90 °. The solid-state imaging device 57,
58 is facing.

The treatment instrument insertion passage 59 is constituted by a branch pipe 60 made of a stainless steel pipe or the like in the distal end hard portion 52.
And a branch insertion passage 62 that is branched in a direction substantially perpendicular to the middle of the straight insertion passage 61. In order to smoothly change the direction of the treatment tool inserted into the branch insertion passage 62, the branch insertion passage 62 has a curved shape at a portion connected to the straight insertion passage 61. The distal end of the straight insertion passage 61 is provided at the distal end surface of the rigid distal end portion 52 where the observation window 52 is provided.
The branch insertion passage 62 serves as a second treatment instrument outlet 62a that opens near the portion of the rigid distal end portion 52 where the observation window 53 is provided.

A treatment tool guide member 63 is used to change the direction of the treatment tool inserted into the treatment tool insertion passage 59 from the straight insertion passage 61 to the branch insertion passage 62 in the branch pipe 60. The treatment instrument guide member 63 is formed of a rod-shaped member, and has a distal end surface serving as a guide surface 63a substantially matching the curved shape of the branch insertion passage 62. On the other hand, a magnet 63b is fixedly provided on the base end side,
When the treatment tool guide member 63 is inserted into the first treatment tool outlet 61a of the straight insertion passage 61 in the branch tube 60, the magnet 63b is fixed by suction to the inner surface of the branch tube 60. As a result, the treatment instrument is inserted into the treatment instrument insertion passage 5.
When the treatment instrument guide member 63 is not mounted when the treatment instrument is inserted into the inside of the treatment instrument 9, the treatment instrument advances straight in the straight insertion passage 61 and is led out from the first treatment tool outlet 61 a. When the treatment tool guide member 63 is mounted, the treatment tool is guided along the guide surface 63a of the treatment tool guide member 63, and the second treatment tool outlet port 62a in the branch insertion passage 62.
Is derived from

With the above configuration, as shown in FIG. 8, for example, when the insertion section 50 is inserted into the patient's body to perform an examination or treatment in the stomach, the distal end hard section is used. Irradiation light is emitted from an illumination window provided in the observation window 52.
The inside of the body is observed, but in this case, the treatment tool guide member 63 is not attached. Then, if necessary, the treatment tool 64 can be inserted through the treatment tool insertion passage 59 and can be led out from the first treatment tool outlet 61a via the straight insertion passage 61.

On the other hand, as shown in FIG. 9, when the treatment tool 65 such as a cannula is inserted from the nipple into the pancreatic bile duct in the digestive tract, the insertion section 50 is attached with the treatment tool guide member 63 attached. Is inserted into the body. And the insertion part 5
Until the hard distal portion 51 reaches the inside of the digestive tract, the insertion operation is performed under observation by the observation window 54 under irradiation of illumination light from the illumination window 52 provided on the distal end surface of the hard distal portion 51. With the distal end hard portion 51 guided to a predetermined position in this way, the treatment tool 65 is inserted into the treatment tool insertion passage 59 while irradiating illumination light from the illumination window and performing observation through the observation window 53. Send in. As a result, the treatment tool 65 is
Of the treatment instrument guide member 63, the branching passage 6 is guided by the guide surface 63a of the treatment instrument guide member 63.
After turning to the second side, from the second treatment instrument outlet 62a,
The treatment tool 65 is led out from a direction substantially 90 ° with respect to the axis of the distal end hard portion 60, and can be reliably inserted into the nipple.

[0025]

As described above, according to the present invention, the treatment instrument insertion passage provided in the insertion portion is opened at the distal end surface of the insertion portion, and one end of the branch passage is connected to the treatment instrument insertion passage. The other end of the branch passage is opened to the side surface of the insertion portion, and a treatment tool guide member for guiding the treatment tool in the branch passage direction can be attached to and detached from a connection portion of the treatment tool insertion passage to the branch passage. Since the treatment tool is drawn out from the distal end surface of the hard distal end portion and also from the side surface portion, a single treatment tool insertion passage can be used in the insertion portion. The filling rate can be suppressed to be low, the diameter can be reduced, and at the angle portion and the like, it is possible to prevent the members inserted therein from being pressed against each other to be damaged, and so on.

[Brief description of the drawings]

FIG. 1 is an overall configuration diagram of an ultrasonic endoscope as an in-vivo examination device according to a first embodiment of the present invention.

FIG. 2 is a sectional view of a distal end portion of FIG.

FIG. 3 is an external view of a distal end surface of FIG.

FIG. 4 is a cross-sectional view of the insertion section in a state where the treatment tool for an endoscope is mounted.

FIG. 5 is a cross-sectional view of the insertion portion in a state where the ultrasonic treatment tool is mounted.

FIG. 6 is an external view of a treatment tool guide member.

FIG. 7 is a sectional view of a main part of a direct / side view type endoscope as an in-vivo inspection apparatus according to a second embodiment of the present invention.

FIG. 8 is a cross-sectional view showing a state in which a treatment tool is inserted into a direct-side view endoscope.

FIG. 9 is a cross-sectional view showing a state in which another treatment tool has been inserted into the direct-side view type endoscope.

[Explanation of symbols]

 1,50 Insertion part 6,51 Hard tip part 11,52,53 Observation window 12 Ultrasonic transducer 13 Endoscope treatment tool 14 Ultrasound treatment tool 20,59 Treatment tool insertion passage 22,60 Branch pipe 23,61 Straight insertion passages 23a, 61a First treatment tool insertion passages 24, 62 Branch insertion passages 24a, 62a Second treatment tool insertion passages 30, 63 Treatment tool guide members 31 Guide portions 31a, 63a Guide surfaces 64, 65 Treatment tools

────────────────────────────────────────────────── ─── Continuation of the front page (56) References JP-A-5-305051 (JP, A) JP-A-2-164329 (JP, A) (58) Fields investigated (Int. Cl. ⁶ , DB name) A61B 1/00-1/32

Claims (1)

(57) [Claims] 1. An inspection means is mounted on a distal end of an insertion portion to be inserted into a body cavity, and a treatment instrument insertion passage is provided in the insertion portion in an axial direction of the insertion portion. The treatment tool insertion passage is connected to one end of a branch passage, the other end of the branch passage is opened to the side surface of the insertion portion, and the connection portion of the treatment tool insertion passage to the branch passage is formed. Wherein a treatment tool guide member for guiding the treatment tool in the direction of the branch passage is detachably mounted.