JP3888359B2 - Endoscope device - Google Patents

Description

The present invention relates to an endoscope apparatus, an endoscope apparatus in particular observing deep digestive tract such as the small intestine or large intestine.

  When inserting the insertion part of the endoscope into the deep digestive tract such as the small intestine, simply pushing the insertion part makes it difficult for force to be transmitted to the distal end of the insertion part due to the complicated bending of the intestinal tract. Have difficulty. For example, if excessive bending or bending occurs in the insertion portion, the insertion portion cannot be inserted further deeper. Therefore, a method has been proposed in which an insertion tube of an endoscope is covered with an overtube and inserted into a body cavity, and the insertion portion is guided by the overtube, thereby preventing excessive bending or bending of the insertion portion.

Patent Documents 1 and 2 describe an endoscope apparatus in which a first balloon is provided at a distal end portion of an insertion portion of an endoscope and a second balloon is provided at a distal end portion of an overtube (also referred to as a sliding tube). ing. According to this endoscope apparatus, first, as shown in FIG. 8A, the endoscope is inserted into the intestinal tract 3 with the overtube 2 placed on the insertion portion 1 of the endoscope, and the distal end 1a of the insertion portion 1 is inserted. Is inserted as deep as possible. And as shown in FIG.8 (b), the 1st balloon 4 with which the front-end | tip part 1a was mounted | worn is expanded and it fixes to the intestinal tract 3. FIG. Next, as shown in FIG. 8C, the insertion portion 1 is brought close to the hand to remove excess deflection of the insertion portion 1, and the insertion portion 1 is made as straight as possible. Next, as shown in FIG. 8D, the overtube 2 is pushed in along the insertion portion 1, and the distal end portion 2 a of the overtube 2 is disposed in the vicinity of the distal end portion 1 a of the insertion portion 1. Then, as shown in FIG. 8 (e), the second balloon 5 is inflated to fix the tip 2 a of the overtube 2 to the intestinal tract 3. Next, as shown in FIG. 8F, after the first balloon 4 is deflated, the insertion portion 1 is inserted again as much as possible. In that case, since the insertion part 1 is guided by the overtube 2, the insertion part 1 can be inserted smoothly. By repeating the above operation, the distal end portion 1a of the insertion portion 1 can be inserted deeply even in the intestinal tract 3 bent in a complicated manner.
Japanese Patent Laid-Open No. 51-11689 JP 11-290263 A

  However, in the above method, as shown in FIG. 8C, the intestinal tract 3 is contracted when the overtube 2 is pushed along the insertion portion 1. There was a possibility that the intestinal tract 3 could be damaged easily.

The present invention has been made in view of such circumstances, and an object of the present invention is to provide an endoscope apparatus in which a body cavity such as an intestinal tract is not damaged.

In order to achieve the above object, the invention according to claim 1 is an endoscope in which a first balloon is attached to a distal end portion of an insertion portion, and the insertion portion covers the insertion portion to guide the insertion of the insertion portion. And an overtube having a second balloon attached to the distal end thereof, and the first balloon or the second balloon is inflated to be fixed to a body cavity. Friction resistance against the body cavity when inflated is larger than that of one balloon.

The invention according to claim 1 is an endoscope apparatus suitable for pulling a body cavity around a second balloon. According to the first aspect of the present invention, since the second balloon has a higher frictional resistance against the body cavity during inflation than the first balloon, it is suitable for grasping and pulling the body cavity. On the other hand, since the first balloon has a small frictional resistance against the body cavity, the burden on the body cavity when inflated is small. Further , in the first aspect of the invention, since the frictional resistances of the first balloon and the second balloon are different from each other, the body cavity is not pulled by the two balloons even if the overtube is pulled by hand while the two balloons are inflated. . As described above, according to the first aspect of the present invention, the endoscope apparatus is suitable for drawing the body cavity from the second balloon as a base point. By using this endoscope apparatus, the burden on the body cavity is reduced. , Can prevent body cavity damage.

According to a second aspect of the present invention, in the first aspect of the invention, the second balloon is larger in size in the natural state in the radial direction of the overtube than the first balloon. Therefore, according to the invention of claim 2 , the second balloon has a higher frictional resistance to the body cavity during inflation than the first balloon.

A third aspect of the invention is characterized in that, in the first aspect of the invention, the second balloon is made of a material having a higher frictional resistance to the body cavity than the first balloon. Therefore, according to the invention of claim 3 , the second balloon has a higher frictional resistance to the body cavity during inflation than the first balloon.

According to a fourth aspect of the present invention, in the first aspect of the present invention, the second balloon is made of a material having a larger expansion rate than the first balloon. Therefore, according to the fourth aspect of the present invention, the second balloon having a larger expansion rate has a larger inflated size than the first balloon, and the frictional resistance into the body cavity is increased.

According to a fifth aspect of the present invention, in the first aspect of the invention, the second balloon has a larger contact area with the body cavity when inflated than the first balloon. Therefore, according to the invention of claim 5 , the second balloon having a larger contact area has a higher frictional resistance.

According to a sixth aspect of the present invention, in the first aspect of the invention, the second balloon is thinner than the first balloon. Therefore, the thin second balloon is easier to expand than the first balloon, and the size when expanded is larger. As a result, the second balloon has a greater frictional resistance to the body cavity during inflation than the first balloon.

A seventh aspect of the invention is characterized in that, in the first aspect of the invention, the air pressure of the second balloon is 26.7 hPa or more and 133.3 hPa or less. Thereby, the second balloon can exhibit a sufficient and stable gripping force.

  In addition, according to the endoscope apparatus according to the present invention, the second balloon has a higher frictional resistance against the body cavity than the first balloon, so that the body cavity can be drawn with the second balloon as a base point, and the body cavity is damaged. Can be prevented.

Hereinafter, preferred embodiments of an endoscope apparatus according to the present invention will be described in detail with reference to the accompanying drawings.

  FIG. 1 shows a system configuration diagram of an endoscope apparatus according to the present invention.

  As shown in FIG. 1, the endoscope apparatus according to the present invention mainly includes an endoscope 10, an overtube 50, and a balloon control apparatus 100.

  The endoscope 10 includes a hand operation unit 14 and an insertion unit 12 connected to the hand operation unit 14. A universal cable 16 is connected to the hand operation unit 14, and a connector (not shown) connected to a processor or a light source device is provided at the end of the universal cable 16.

  The hand operation unit 14 is provided with an air / water supply button 16, a suction button 18, and a shutter button 20, and a pair of angle knobs 22 and 22 and a forceps insertion unit 24. Further, the hand operating unit 14 is provided with a balloon air supply port 26 for supplying air to a balloon 30 to be described later or sucking air from the balloon 30.

  The insertion portion 12 includes a flexible portion 32, a bending portion 34, and a distal end portion 36. The bending portion 34 is remotely bent by turning a pair of angle knobs 22 and 22 provided in the hand operation portion 14. Thereby, the front end surface 37 of the front end portion 36 can be directed in a desired direction.

  As shown in FIG. 2, an objective optical system 38, an illumination lens 40, an air / water supply nozzle 42, a forceps port 44, and the like are provided on the distal end surface 37 of the distal end portion 36. An air supply / suction port 28 is provided on the outer peripheral surface of the distal end portion 36. The air supply / suction port 28 communicates with the balloon air supply port 26 of FIG. 1 via an air supply tube (not shown) having an inner diameter of about 0.8 mm inserted into the insertion portion 12. Accordingly, air is blown from the air supply / suction port 28 of the tip 36 by supplying air to the balloon supply port 26, and the air supply / suction port of the tip 36 by sucking air from the balloon supply port 26. Air is sucked from 28.

  As shown in FIG. 1, a first balloon 30 made of an elastic material such as rubber is detachably attached to the distal end portion 36 of the insertion portion 12. As shown in FIG. 3, the first balloon 30 includes a central bulging portion 30c and attachment portions 30a and 30b at both ends thereof, and the air supply / suction port 28 is disposed inside the bulging portion 30c. Can be attached. A thread (not shown) is wound around the attachment portions 30a and 30b and fixed so as to be in close contact with the outer peripheral surface of the insertion portion 12 over the entire circumference. Instead of winding the yarn, the fixing ring may be fixed by being fitted to the attachment portions 30a and 30b.

  In the first balloon 30 mounted as described above, the bulging portion 30 c expands into a substantially spherical shape by blowing air from the air supply suction port 28, and the bulging portion 30 c by sucking air from the air supply suction port 28. Contracts and sticks to the outer peripheral surface of the tip portion 36.

  On the other hand, as shown in FIGS. 4 and 5, the overtube 50 is formed in a cylindrical shape, has an inner diameter slightly larger than the outer diameter of the insertion portion 12, and has sufficient flexibility. A rigid grip 52 is provided at the base end of the overtube 50, and the insertion portion 12 is inserted from the grip 52.

  A balloon air supply port 54 is provided on the proximal end side of the overtube 50. An air supply tube 56 having an inner diameter of about 1 mm is connected to the balloon air supply port 54. The tube 56 is bonded to the outer peripheral surface of the overtube 50 and extends to the tip of the overtube 50. .

  The tip 58 of the overtube 50 is tapered and has a tapered shape. A second balloon 60 made of an elastic body such as rubber is mounted near the tip 58 of the overtube 50. The second balloon 60 is mounted in a state where the overtube 50 penetrates, and includes a central bulging portion 60c and attachment portions 60a and 60b at both ends thereof. The distal end side attachment portion 60a is folded back inside the bulging portion 60c, and an X-ray contrast thread 62 is wound around the folded attachment portion 60a. The proximal-side attachment portion 60b is disposed outside the second balloon 60, and is fixed to the overtube 50 by winding a thread 64 around it.

  The bulging portion 60c is formed in a substantially spherical shape in a natural state (that is, a state in which neither is expanded nor contracted), and the size thereof is larger than the size of the first balloon 30 in the natural state. . Therefore, when air is supplied to the first balloon 30 and the second balloon 60 at the same pressure, the outer diameter of the bulging portion 60c of the second balloon is larger than the outer diameter of the bulging portion 30c of the first balloon 30. . For example, the outer diameter of the second balloon 60 is configured to be φ50 mm when the outer diameter of the first balloon 30 is φ25 mm.

  The above-described tube 56 is opened inside the bulging portion 60c, and an air supply / suction port 57 is formed. Therefore, when air is supplied from the balloon air supply port 54, air is blown out from the air supply / suction port 57, and the bulging portion 60c is expanded. When air is sucked from the balloon air supply port 54, air is sucked from the air supply suction port 57, and the second balloon 60 is deflated. 4 is an inlet for injecting a lubricant such as water into the overtube 50.

  The balloon control device 100 of FIG. 1 is a device that supplies and sucks fluid such as air to the first balloon 30 and supplies and sucks fluid such as air to the second balloon 60. The balloon control device 100 includes a device main body 102 having a pump, a sequencer, and the like (not shown) and a hand switch 104 for remote control.

  On the front panel of the apparatus main body 102, a power switch SW1, a stop switch SW2, a pressure gauge 106 for the first balloon 30 and a pressure gauge 108 for the second balloon 60 are provided.

  Further, a tube 110 that supplies and sucks air to the first balloon 30 and a tube 120 that supplies and sucks air to the second balloon 60 are attached to the front panel of the apparatus main body 102. Reservoir tanks 130 and 140 for preventing backflow of body fluid when the first balloon 30 and the second balloon 60 are torn are provided in the middle of the tubes 110 and 120, respectively.

  On the other hand, the hand switch 104 includes a stop switch SW3 similar to the stop switch SW2 on the apparatus body 102 side, an ON / OFF switch SW4 that supports pressurization / decompression of the first balloon 30, and the pressure of the first balloon 30. A pause switch SW5 for holding, an ON / OFF switch SW6 for supporting the pressurization / depressurization of the second balloon 60, and a pause switch SW7 for holding the pressure of the second balloon 60 are provided. The hand switch 104 is electrically connected to the apparatus main body 102 via a cord 150.

  The balloon control device 100 configured as described above supplies air to the balloons 30 and 60 to inflate them, and controls the air pressure to a constant value to hold the balloons 30 and 60 in an inflated state. In addition, air is sucked from the balloons 30 and 60 and contracted, and the air pressure is controlled to a constant value to hold the balloons 30 and 60 in a contracted state.

  Next, an operation method of the endoscope apparatus configured as described above will be described with reference to FIGS.

  First, as shown in FIG. 6A, the insertion portion 12 is inserted into the intestinal tract (for example, the descending leg of the duodenum) 70 with the overtube 50 placed on the insertion portion 12. At this time, the first balloon 30 and the second balloon 60 are deflated.

  Next, as shown in FIG. 6B, the second balloon 60 is inflated by supplying air to the second balloon 60 in a state where the tip 58 of the overtube 50 is inserted up to the bent portion of the intestinal tract 70. As a result, the second balloon 60 is locked to the intestinal tract 70, and the tip 58 of the overtube 50 is fixed to the intestinal tract 70.

  Next, as shown in FIG. 6C, only the insertion portion 12 of the endoscope 10 is inserted into the deep portion of the intestinal tract 70 (insertion operation). Then, as shown in FIG. 6D, air is supplied to the first balloon 30 to be inflated. Thereby, the first balloon 30 is fixed to the intestinal tract 70 (fixing operation). At that time, since the first balloon 30 is smaller than the second balloon 60 when inflated, the burden on the intestinal tract 70 is small, and damage to the intestinal tract 70 can be prevented.

  Next, after the air is sucked from the second balloon 60 to contract the second balloon 60, the overtube 50 is pushed in and inserted along the insertion portion 12 as shown in FIG. operation). And after holding the front-end | tip 58 of the overtube 50 to the 1st balloon 30 vicinity, as shown in FIG.6 (f), air is supplied to the 2nd balloon 60, and it is made to expand. Thereby, the second balloon 60 is fixed to the intestinal tract 70. That is, the intestinal tract 70 is grasped by the second balloon 60 (gripping operation).

  Next, as shown in FIG.6 (g), the overtube 50 is drawn around (hand feeding operation). Thereby, the intestinal tract 70 is in a contracted state, and the excess bending or bending of the overtube 50 is eliminated. It should be noted that when the overtube 50 is pulled together, both the first balloon 30 and the second balloon 60 are locked to the intestinal tract 70, but the frictional resistance of the first balloon 30 is higher than the frictional resistance of the second balloon 60. small. Therefore, even if the first balloon 30 and the second balloon 60 move relative to each other, the first balloon 30 having a small frictional resistance slides with respect to the intestinal tract 70, so that the intestinal tract 70 is connected to both the balloons 30, 60. It can be prevented from being damaged by being pulled by.

  Next, as shown in FIG. 6 (h), air is sucked from the first balloon 30 to contract the first tube 30. Then, the distal end portion 36 of the insertion portion 12 is inserted as deep as possible into the intestinal tract 70. That is, the insertion operation shown in FIG. Thereby, the front-end | tip part 36 of the insertion part 12 can be inserted in the deep part of the intestinal tract 70. FIG. When inserting the insertion portion 12 into a deeper portion, after performing a fixing operation as shown in FIG. 6D, a pushing operation as shown in FIG. ), A hand dragging operation as shown in FIG. 6G, and an insertion operation as shown in FIG. Thereby, the insertion part 12 can be further inserted into the deep part of the intestinal tract 70.

  As described above, according to the present embodiment, the insertion operation of the insertion portion 12, the fixing operation of the insertion portion 12, the pushing operation of the overtube 50, the gripping operation of the intestinal tract 70 by the second balloon 60, and the hand feeding operation of the overtube 50 By repeating the above, the insertion portion 12 can be inserted into the deep portion of the intestinal tract 70.

  In addition, according to the present embodiment, the intestinal tract 70 is brought together with the second balloon 60 as a base point, and therefore, unlike the case where the intestinal tract 70 is brought together with the first balloon 30 as a base point, there is no possibility of damaging the intestinal tract 70. In other words, when the intestinal tract 70 is brought close to the first balloon 30 (see FIG. 8), the contracted intestinal tract 70 is easily caught in the overtube 50, whereas the intestinal tract 70 is based on the second balloon 60. In the case of handing over, the overtube 50 is pushed into the intestinal tract 70 in a natural state (not contracted), so that the intestinal tract 70 is not caught and damage to the intestinal tract 70 can be prevented.

  In particular, in the endoscope apparatus of the present embodiment, since the first balloon 30 is formed smaller than the second balloon 60, the intestinal tract 70 cannot be gripped by the first balloon 30, and the first balloon 30. It is not possible to perform a drag operation based on. Therefore, damage to the intestinal tract 70 can be reliably prevented.

  Furthermore, according to the present embodiment, the friction resistance against the intestinal tract 70 is different between the first balloon 30 and the second balloon 60, so that even if the overtube 50 is pulled close together with both the balloons 30, 60 inflated. The intestinal tract 70 is not pulled by both the balloons 30 and 60, and damage to the intestinal tract 70 can be reliably prevented.

  The second balloon 60 only needs to have a greater frictional resistance to the intestinal tract 70 during inflation than the first balloon 30. Therefore, for example, the first balloon 30 and the second balloon 60 having the same size in the natural state are used, and the air pressure of the second balloon 60 at the time of inflation is larger than the air pressure of the first balloon 30. As such, air may be supplied. As a result, the second balloon 60 is inflated larger than the first balloon 30, so that the friction resistance against the intestinal tract 70 is greater in the second balloon 60 than in the first balloon 30.

  In that case, it is preferable that the air pressure of the 2nd balloon 60 is 26.7 hPa or more and 133.3 hPa or less. Experiments have shown that when the air pressure is set in such a range, the second balloon 60 during inflation exhibits a sufficient and stable gripping force against the intestinal tract 70. Here, the experiment is to open a dog under general anesthesia, insert a latex balloon attached to the tip of a 10 mm diameter, 15 cm long rod through the incision formed in the jejunum, and pull it out with air pressure This is a study of the relationship of resistance. The result is shown in FIG. As can be seen from the table in the figure, when the air pressure is less than 26.7 hPa, there is a problem that the gripping force is insufficient. On the other hand, when the air pressure is higher than 133.3 hPa, the gripping force becomes unstable, and there is a possibility that a great burden is imposed on the intestinal tract. Therefore, it can be seen that the air pressure is preferably 26.7 hPa or more and 133.3 hPa or less.

  In addition, the first balloon 30 and the second balloon 60 having the same size in the natural state may be used, and the thickness of the second balloon 60 may be smaller than the thickness of the first balloon 30. In this case, if air is supplied to both the balloons 30 and 60 at a constant pressure, the second balloon 60 expands more than the first balloon 30, so that the friction resistance with respect to the intestinal tract 70 is higher in the second balloon 60. It becomes larger than the balloon 30.

  Further, the frictional resistance against the intestinal tract 70 may be changed by manufacturing the first balloon 30 and the second balloon 60 with different materials. For example, the first balloon 30 may be made of a material having a low frictional resistance (for example, silicon rubber), and the second balloon 60 may be made of a material having a high frictional resistance (for example, natural rubber). In this case, even if the first balloon 30 and the second balloon 60 have the same size and shape at the time of inflation, the friction resistance against the intestinal tract 70 is greater in the second balloon 60 than in the first balloon 30.

  Alternatively, the first balloon 30 may be made of a material having a low expansion rate, and the second balloon 60 may be made of a material having a high expansion rate. In this case, when a constant pressure of air is supplied to the first balloon 30 and the second balloon 60, the second balloon 60 expands more than the first balloon 30. Therefore, the frictional resistance against the intestinal tract 70 is reduced by the second balloon 60. Is larger than the first balloon 30.

  Furthermore, the frictional resistance against the intestinal tract 70 may be changed by changing the shapes of the first balloon 30 and the second balloon 60 when they are inflated. For example, the second balloon 80 shown in FIG. 7A is formed in an oval shape in which the cross-sectional shape when expanded is long in the axial direction of the overtube 50. Therefore, since the second balloon 80 is in surface contact with the intestinal tract 70 (see FIG. 6) at the circumferential surface 80d, the frictional resistance against the intestinal tract 70 is increased. Similarly, the second balloon 82 shown in FIG. 7B and the second balloon 84 shown in FIG. 7C are provided with circumferential surfaces 82d and 84d that are in surface contact with the intestinal tract 70, respectively. High frictional resistance. 7A to 7C, each balloon 80, 82, 84 may be held in a desired shape by covering each balloon 80, 82, 84 with a net.

System configuration diagram of an endoscope apparatus according to the present invention The perspective view which shows the front-end | tip part of the insertion part of an endoscope The perspective view which shows the front-end | tip part of the insertion part with which the 1st balloon was mounted | worn. Side sectional view showing the overtube Side sectional view showing the tip of the overtube through which the insertion section is inserted Explanatory drawing which shows the operating method of the endoscope apparatus which concerns on this invention Side sectional view showing second balloon of different shape Explanatory drawing which shows the operation method of the conventional endoscope apparatus Table showing experimental results

Explanation of symbols

  DESCRIPTION OF SYMBOLS 10 ... Endoscope, 12 ... Insertion part, 14 ... Hand operation part, 26 ... Balloon air supply port, 28 ... Air supply suction port, 30 ... 1st balloon, 36 ... Tip part, 50 ... Overtube, 52 ... Grasp , 54 ... balloon air inlet, 56 ... tube, 58 ... tip, 60 ... second balloon, 62 ... X-ray contrast thread, 64 ... thread, 66 ... inlet, 100 ... balloon control device, 102 ... device main body, 104 ... Hand switch

Claims (7)

An endoscope in which a first balloon is attached to a distal end portion of an insertion portion; and an overtube that is placed on the insertion portion, guides insertion of the insertion portion, and has a second balloon attached to the distal end portion. An endoscope device that is fixed to a body cavity by inflating the first balloon or the second balloon;
The endoscope apparatus characterized in that the second balloon has a higher frictional resistance to the body cavity when inflated than the first balloon. The endoscope apparatus according to claim 1 , wherein the second balloon has a larger natural size in the radial direction of the overtube than the first balloon. The endoscope apparatus according to claim 1 , wherein the second balloon is made of a material having a higher frictional resistance to the body cavity than the first balloon. The endoscope apparatus according to claim 1 , wherein the second balloon is made of a material having a higher expansion rate than the first balloon. The endoscope apparatus according to claim 1 , wherein the second balloon has a larger contact area with the body cavity when inflated than the first balloon. The endoscope apparatus according to claim 1 , wherein the second balloon is thinner than the first balloon. The endoscope apparatus according to claim 1 , wherein an air pressure of the second balloon is 26.7 hPa or more and 133.3 hPa or less.

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