CN116867418A - Guide device for medical instrument and endoscope device - Google Patents

Abstract

The invention provides a guide device for medical instrument and an endoscope device capable of improving the insertion performance of medical instrument. The guide device for medical instruments of the present invention comprises: a hose body (606) having a flexible outer hose (602) and a flexible inner hose (604) disposed inside the outer hose (602); and a shape variable body (612) that is provided between the outer hose (602) and the inner hose (604) and is deformable in conformity with the shape of the hose body (606).

Description

Guide device for medical instrument and endoscope device

Technical Field

The present invention relates to a medical instrument guide device and an endoscope device for guiding a medical instrument such as an insertion portion of an endoscope into a body.

Background

An insertion portion of an endoscope (hereinafter, also referred to as an "endoscope insertion portion") is inserted along a flexible insertion path that is curved, for example, along an upper gastrointestinal tract, a lower gastrointestinal tract, or the like. Therefore, the endoscope insertion portion has flexibility capable of being inserted along the insertion path.

The intestinal tract, which is an example of the insertion path, has a portion (e.g., sigmoid colon) that is not fixed to the body, and when the endoscope insertion portion is inserted, the portion deforms halfway even if the insertion portion is pushed in, and therefore, the distal end portion of the insertion portion is difficult to advance. In addition, during treatment of an endoscope, a precise operation of guiding a treatment tool from the distal end portion of the insertion portion to remove a lesion may be performed, but the precise operation may be hindered by deformation of the portion.

Accordingly, patent document 1 discloses a guide tube for eliminating unstable operations at the time of insertion and at the time of disposal. The guide tube of patent document 1 has a structure in which an elongated rib having an engagement surface and a strength retaining member is disposed in a sealed space between an inner tube and an outer tube having flexibility, and fluid is discharged from the sealed space to press the engagement surface against at least one of the inner tube and the outer tube to set the pressure state, and fluid is supplied into the sealed space to release the pressure state. According to this guide tube, a change in hardness between a flexible state and a high-rigidity state in the bending direction can be generated.

Technical literature of the prior art

Patent literature

Patent document 1: japanese patent application laid-open No. 2011-194126

Disclosure of Invention

Technical problem to be solved by the invention

However, when the hardness of the guide tube (guide device for medical instrument) is changed to a high-rigidity state, it is difficult to sufficiently secure the contact area between the engaging surface of the rib and the inner tube or the outer tube as in patent document 1. Therefore, it is difficult to maintain the shape of the guide device for medical instruments in a curved shape along the curved portion of the intestinal tract, and there is a problem that the insertion performance of medical instruments such as an endoscope insertion portion and a treatment instrument is lowered. On the other hand, if the number of ribs is increased, the contact area can be sufficiently ensured, but in this case, the flexibility of the guide device for medical instruments is impaired, and therefore there is a problem that the insertion of medical instruments is reduced.

The present invention has been made in view of such circumstances, and an object thereof is to provide a medical instrument guide device and an endoscope device capable of improving insertion performance of a medical instrument.

Means for solving the technical problems

In order to solve the above-described problems, a medical instrument guide device according to the present invention is a medical instrument guide device for guiding a medical instrument into a body, comprising: a hose body having a flexible outer hose and a flexible inner hose disposed inside the outer hose; and a shape-variable body provided between the outer hose and the inner hose and capable of being deformed in conformity with the shape of the hose body.

According to one aspect of the present invention, it is preferable that the guide device for a medical device includes an intermediate layer provided between the outer hose and the inner hose and capable of being brought into contact with the shape-variable body, the guide device for a medical device includes a 1 st contact surface provided on the shape-variable body and a 2 nd contact surface provided on the intermediate layer and opposed to the 1 st contact surface, and at least a part of at least one of the 1 st contact surface and the 2 nd contact surface includes a high friction surface.

According to one aspect of the present invention, the intermediate layer is preferably provided between the outer hose and the shape variable member.

According to one aspect of the present invention, the high friction surface is preferably provided on the 2 nd contact surface.

According to one aspect of the present invention, the high friction surface is preferably provided on the 1 st contact surface.

According to one aspect of the present invention, the intermediate layer preferably has an elastic modulus higher than that of the outer hose and the inner hose.

According to one aspect of the present invention, the intermediate layer is preferably formed by forming a sheet into a cylindrical shape.

According to one aspect of the present invention, it is preferable that the hose further comprises a fluid supply/discharge mechanism for supplying fluid to and discharging fluid from an inner space between the outer hose and the inner hose, wherein the shape variable body and the intermediate layer are frictionally engaged with each other via the high friction surface in the hose body when the fluid in the inner space is discharged by the fluid supply/discharge mechanism, thereby maintaining the shape of the shape variable body.

According to one aspect of the present invention, it is preferable that the flexible hose has a 1 st contact surface provided on the shape-variable body and a 2 nd contact surface provided on at least one of the outer hose and the inner hose and facing the 1 st contact surface, and at least a part of any one of the 1 st contact surface and the 2 nd contact surface includes a high friction surface.

According to one aspect of the present invention, it is preferable that the hose further comprises a fluid supply/discharge mechanism for supplying fluid to and discharging fluid from an inner space between the outer hose and the inner hose, wherein when the fluid in the inner space is discharged by the fluid supply/discharge mechanism, the shape variable member is frictionally engaged with one of the hoses via the high friction surface in the hose body, thereby maintaining the shape of the shape variable member.

According to one aspect of the present invention, the high friction surface is preferably a resin layer formed by coating a resin on one of the contact surfaces.

According to one aspect of the present invention, the high friction surface is preferably a roughened surface formed on one of the contact surfaces.

According to one aspect of the present invention, the high friction surface is preferably a resin layer formed by coating a resin on a roughened surface formed on one of the contact surfaces.

According to one aspect of the present invention, the shape variable member preferably has a spiral tube formed by winding a band-shaped member in a spiral shape on the outer peripheral side of the inner hose.

According to one aspect of the present invention, it is preferable that the shape variable member has a plurality of joint ring members arranged along an axial direction of the hose body, and the joint ring member has: an annular fixing ring member provided so as to be capable of fixing a relative position with respect to an axial direction of the outer hose or the inner hose; and a plurality of joint pieces extending in a comb-tooth shape from the fixed ring member to at least one side in the axial direction, the plurality of joint pieces being arranged in a circumferential direction around the axial direction.

According to one aspect of the present invention, the joint ring member preferably has a plurality of joint pieces extending from the fixing ring member to both sides in the axial direction.

According to one aspect of the present invention, it is preferable that, when the 1 st joint ring member and the 2 nd joint ring member are the joint ring members adjacent to each other in the axial direction, the 1 st joint ring member is the 1 st joint ring member, the 2 nd joint ring member is the 2 nd joint ring member, and the 2 nd joint ring member is the 2 nd joint ring member, the 1 st joint ring member-side 1 st joint ring member end region of the 1 st joint ring member and the 2 nd joint ring member-side 2 joint ring member end region of the 2 nd joint ring member are arranged at positions overlapping each other, and the circumferential positions are arranged at positions offset from each other.

In one embodiment of the present invention, the 1 st joint piece and the 2 nd joint piece are preferably alternately arranged one by one in the circumferential direction.

According to one aspect of the present invention, it is preferable that the 1 st joint segment group composed of 2 or more 1 st joint segments and the 2 nd joint segment group composed of 2 or more 2 nd joint segments are alternately arranged in the circumferential direction

According to one aspect of the present invention, it is preferable that, when the 1 st joint ring member and the 2 nd joint ring member are set as the joint ring members adjacent to each other in the axial direction, the 1 st joint ring member is set as the 1 st joint ring member, the joint plate extending toward the 2 nd joint ring member is set as the 1 st joint plate, and the 2 nd joint ring member is set as the 2 nd joint plate, the positions in the axial direction of the 1 st joint plate and the 2 nd joint plate are arranged at positions offset from each other, and the positions in the circumferential direction are arranged at positions offset from each other.

According to one aspect of the present invention, when the width of the joint ring member in the axial direction is set to W1 and the arrangement pitch of the joint ring member in the axial direction is set to P, the following expression P < W1 is preferably satisfied.

According to one aspect of the present invention, when the width in the axial direction of the joint ring member is W1 and the arrangement pitch in the axial direction of the joint ring member is P, the following expression P > W1 is preferably satisfied.

According to one aspect of the present invention, it is preferable that the plurality of joint pieces arranged in the circumferential direction are arranged at equal intervals in the circumferential direction.

According to one aspect of the present invention, the plurality of fixing ring members are preferably arranged at equal intervals in the axial direction.

According to one aspect of the present invention, it is preferable that the joint sheet has: a rectangular sheet main body formed to be elongated in the axial direction; and a connecting member provided between the sheet main body and the fixing ring member and formed to have a width smaller than that of the sheet main body.

According to one aspect of the present invention, it is preferable that at least one of the outer peripheral surface of the outer hose and the inner peripheral surface of the inner hose has a hydrophilic coating.

According to one aspect of the present invention, the medical instrument is preferably an endoscope having an insertion portion to be inserted into the body.

According to one aspect of the present invention, it is preferable that the guide device for a medical instrument includes a switching member capable of switching between opening of the atmosphere and inflow of the atmosphere to an internal space located between the outer tube and the inner tube.

According to one aspect of the present invention, the hose body preferably has an internal sealing portion provided at a distal end portion of the hose body.

According to one aspect of the present invention, the internal sealing portion is preferably constituted by a balloon for a hose body which is disposed at a distal end portion of the hose body and is expandable and contractible.

According to one aspect of the present invention, the internal sealing portion is preferably configured to have a suction port disposed at a distal end portion of the hose body.

According to one aspect of the present invention, the internal sealing portion preferably has a porous anti-rolling member covering the suction port.

In order to solve the above-described problems, an endoscope apparatus according to the present invention includes a medical instrument and a guide device for a medical instrument according to the present invention, and the medical instrument is an endoscope having an insertion portion that can be inserted into a body.

According to one aspect of the present invention, the endoscope preferably includes a switching unit capable of switching between opening of the atmosphere and inflow of the atmosphere to an internal space located between the outer tube and the inner tube.

According to one aspect of the present invention, it is preferable that the insertion portion is insertable into the hose body, and a gap for preventing the pinching of the tissue in the body is formed between the hose body and the insertion portion in a state where the insertion portion is inserted into the hose body.

According to an aspect of the present invention, the gap is preferably 4mm or less.

According to one aspect of the present invention, it is preferable that the insertion portion has an effective length longer than the total length of the hose body by 300mm or more.

According to one aspect of the present invention, the insertion portion preferably includes an inflatable and contractible insertion portion balloon provided at a distal end portion of the insertion portion.

Effects of the invention

According to the present invention, the insertion performance of the medical device can be improved.

Drawings

Fig. 1 is an external view of an endoscope apparatus according to embodiment 1 of the present invention.

Fig. 2 is an enlarged cross-sectional view showing a main part of the structure of the guide tube of fig. 1.

Fig. 3 is a perspective view showing a configuration of a shape-variable body provided in the guide tube of fig. 1.

Fig. 4 is an explanatory view schematically showing the arrangement position of the joint ring member of fig. 3.

Fig. 5 is a schematic view of a curved hose body.

Fig. 6 is an explanatory view of the treatment of a lesion using a guide tube.

Fig. 7 is an explanatory view of the treatment of a lesion using only an endoscope.

Fig. 8 is an explanatory diagram schematically showing the arrangement position of the joint ring member of the guide tube according to embodiment 2.

Fig. 9 is an explanatory diagram schematically showing the arrangement position of the joint ring member of the guide tube according to embodiment 3.

Fig. 10 is an explanatory diagram schematically showing the arrangement position of the joint ring member of the guide tube according to embodiment 4.

Fig. 11 is an explanatory diagram schematically showing the arrangement position of the joint ring member of the guide tube according to embodiment 5.

Fig. 12 is a structural view of a spiral pipe used in the guide pipe according to embodiment 6.

Fig. 13 is an explanatory view of the spiral tube deformed into a curved shape.

Fig. 14 is an enlarged cross-sectional view showing the structure of a guide tube according to embodiment 7.

Fig. 15 is a longitudinal cross-sectional view of the guide tube taken along line 15-15 of fig. 14.

Fig. 16 is an enlarged cross-sectional view of a main portion of the base end side of the guide tube shown in fig. 14.

Fig. 17 is an enlarged cross-sectional view of a main portion of the distal end side of the guide tube shown in fig. 14.

Fig. 18 is an external view of the spiral pipe.

Fig. 19 is an explanatory view of the spiral pipe shown in fig. 18 deformed into a curved shape.

Fig. 20 is a perspective view of a sheet.

Fig. 21 is a front view of the sheet shown in fig. 20.

Fig. 22 is a side view showing modification 1 of the spiral pipe.

Fig. 23 is an external view showing modification 2 of the spiral pipe.

Fig. 24 is an external view showing modification 3 of the spiral pipe.

Fig. 25 is an external view showing a 4 th modification of the spiral pipe.

Fig. 26 is an external view showing a modification 5 of the spiral pipe.

Fig. 27 is a longitudinal sectional view showing the structure of a guide tube according to embodiment 8.

Fig. 28 is a perspective view of an endoscope apparatus according to embodiment 2 of the present invention.

Fig. 29 is a cross-sectional view of the guide tube with the insertion portion inserted.

Fig. 30 is a piping diagram when a pump is used in combination.

Fig. 31 is an explanatory view showing an operation procedure of the endoscope apparatus shown in fig. 28.

Fig. 32 is an explanatory view showing an operation procedure of the endoscope apparatus shown in fig. 28.

Fig. 33 is a cross-sectional view showing a balloon according to modification 1.

Fig. 34 is a cross-sectional view showing a balloon according to modification 2.

Fig. 35 is a cross-sectional view showing a balloon according to modification 3.

Fig. 36 is a cross-sectional view showing a balloon according to modification 4.

Fig. 37 is a cross-sectional view showing a balloon according to modification 5.

Fig. 38 is a front view of a balloon according to modification 6.

Fig. 39 is a perspective view of a main part of a hose body to which the internal sealing portion is applied.

Fig. 40 is a main part sectional view of the hose body shown in fig. 39.

Detailed Description

Embodiments of a guide device for medical instruments and an endoscope device according to the present invention will be described below with reference to the drawings.

Fig. 1 is an external view of an endoscope apparatus 1 according to embodiment 1 of the present invention. As shown in fig. 1, an endoscope apparatus 1 includes a guide device (hereinafter, referred to as a "guide tube") 10 for medical instruments according to embodiment 1 and an endoscope 12. Fig. 1 shows a mode in which the insertion portion 14 of the endoscope 12 is inserted through the guide tube 10. In fig. 1, the endoscope 12 includes an insertion portion 14 and a hand-held operation portion 16, and a proximal end side of the insertion portion 14 is coupled to the hand-held operation portion 16. Here, the endoscope 12 having the insertion portion 14 is an example of the medical instrument of the present invention.

The insertion portion 14 is configured by connecting a distal hard portion 18, a bent portion 20, and a soft portion 22 in this order from the distal end side toward the proximal end side. In fig. 1, the distal end hard portion 18 and the bent portion 20 are shown in a state protruding from the distal end opening 10A of the guide tube 10 to the outside.

The distal end hard portion 18 is provided with: a pair of illumination windows 24 for illuminating the body; and viewing windows 26 for capturing images of the body under illumination from these illumination windows 24. The distal end hard portion 18 is provided with a treatment instrument outlet, not shown, for leading out a treatment instrument such as forceps or a high-frequency treatment instrument. On the other hand, the bending portion 20 is bent in a desired direction by operating an unillustrated corner knob provided in the hand-held operation portion 16. The soft portion 22 is formed of a soft member having flexibility in the bending direction. Since the structure of the endoscope 12 is conventionally known, detailed illustration and description thereof are omitted here. The guide tube 10 according to embodiment 1 will be described below.

Fig. 2 is an enlarged cross-sectional view showing a main part of the structure of the guide tube 10. As shown in fig. 2, the guide tube 10 has a hose body 34 having a double-tube structure, and the hose body 34 has a flexible outer hose 30 and a flexible inner hose 32 disposed inside the outer hose 30. The outer tube 30 and the inner tube 32 are each made of, for example, a soft resin material capable of being bent along a bending portion of the intestinal tract. As the soft resin material, urethane or polyester resin can be exemplified, but is not limited thereto. The thickness of each of the outer tube 30 and the inner tube 32 is, for example, about 100 μm, and the thickness of the inner space 36 between the outer tube 30 and the inner tube 32 is, for example, about 800 μm. The thickness of each of the outer tube 30, the inner tube 32, and the inner space 36 is not limited to the above thickness, and is set according to the diameter of the insertion portion 14 (see fig. 1), the diameter of the insertion path of the object into which the insertion portion 14 is inserted, and the like.

The inner space 36 is a space formed in an annular shape (ring shape) so as to surround the periphery (outer periphery) of the inner tube 32 in a cross-sectional shape in a direction orthogonal to the axis Ax of the guide tube 10, and a shape variable body 28 described later is disposed. The inner space 36 is formed as a closed space by sealing the outer hose 30 and the inner hose 32 at the distal end side and the proximal end side of the hose body 34. As shown in fig. 1, a pump 38 for supplying a fluid (e.g., air) to the internal space 36 and discharging the fluid from the internal space 36 is connected to the guide tube 10 via a pipe 40. Here, the pump 38 and the pipe 40 function as the fluid supply/discharge mechanism of the present invention.

The shape-variable body 28 is disposed between the outer hose 30 and the inner hose 32 (i.e., the above-described inner space 36). The shape variable body 28 is deformable in accordance with the shape of the hose body 34, and has a plurality of joint ring members 42 arranged along the axis Ax direction of the hose body 34 as described later.

The plurality of joint ring members 42 constituting the shape-variable body 28 will be described in detail below with reference to fig. 3. Fig. 3 is a perspective view showing the structure of the shape-variable body 28 provided in the guide tube 10. In fig. 3, 2 joint ring members 42A, 42B adjacent in the axial Ax direction among the plurality of joint ring members 42 are shown. Here, the joint ring member 42 corresponds to the joint ring member of the present invention. The joint ring member 42A corresponds to the 1 st joint ring member of the present invention, and the joint ring member 42B corresponds to the 2 nd joint ring member of the present invention.

The plurality of joint ring members 42 (see fig. 2) constituting the shape-variable body 28 are arranged at equal intervals along the axial Ax direction of the hose main body 34, and each joint ring member 42 has the same structure. As shown in fig. 3, the 2 joint ring members 42A, 42B adjacent to each other in the axial direction Ax are arranged in a state in which the positions of the joint ring members 42A, 42B in the circumferential direction C around the axial direction Ax are shifted from each other so that the joint pieces 48 described later do not interfere with each other.

The joint ring member 42 (42A, 42B) includes: the fixing ring member 46 is formed in a circular ring shape so as to surround the periphery (outer periphery) of the inner hose 32; and a plurality of joint pieces 48 extending in a comb-tooth shape from the fixed ring member 46 to both sides in the axial direction Ax. In the joint ring member 42, the fixed ring member 46 and the plurality of joint pieces 48 are formed integrally from the same material. The joint ring member 42 is preferably formed of a resin material such as polypropylene resin. The joint ring member 42 may be made of a metal material such as stainless steel.

The fixing ring member 46 is provided so as to be able to fix the relative position with respect to the axis Ax direction of the outer hose 30 or the inner hose 32. As shown in fig. 2, the fixing ring member 46 of the present embodiment has a fixing piece 49 protruding toward the inner hose 32 side, and the fixing piece 49 is fixed to the outer peripheral surface of the inner hose 32 by a fixing method such as adhesion. As a result, the fixing ring member 46 is fixed at the above-described relative position. The fixing method of the fixing ring member 46 is not limited to the configuration shown in fig. 2, and may be a method in which the fixing piece 49 protrudes toward the outer hose 30 side and is fixed to the inner peripheral surface of the outer hose 30, or a method in which the fixing piece 49 protrudes toward both the inner hose 32 side and the outer hose 30 side and is fixed to both the inner hose 32 and the outer hose 30.

As shown in fig. 3, the plurality of joint pieces 48 extend in a comb-tooth shape from the fixed ring member 46 to both sides in the axial direction Ax. The joint pieces 48 extending to one side from the fixed ring member 46 are arranged at equal intervals along the circumferential direction C around the axis Ax in a form that mimics the shape (annular shape) of the fixed ring member 46.

The joint sheet 48 has a sheet main body 50 and a connecting member 52. The sheet main body 50 is formed in an elongated rectangular shape along the axis Ax direction. The connecting member 52 connects the sheet main body 50 and the fixing ring member 46. The coupling member 52 is formed to have a smaller width than the sheet main body 50, and has a function of smoothly extending the sheet main body 50 in the bending direction of the hose main body 34 with respect to the fixing ring member 46 when the hose main body 34 is bent, for example, along the bending portion of the intestinal tract.

The joint ring member 42 has a high friction surface 54 on a surface (hereinafter referred to as "1 st contact surface") that contacts the outer hose 30. Specifically, the 1 st contact surface of both the fixing ring member 46 and the joint sheet 48 constituting the joint ring member 42 is provided with a high friction surface 54. Here, when the air in the internal space 36 is discharged by the pump 38 (see fig. 1), the inner peripheral surface of the outer hose 30 is pressed to be in close contact with the joint ring member 42, and the outer peripheral surface of the inner hose 32 is pressed to be in close contact with the joint ring member 42, whereby the position of the joint ring member 42 is fixed. As a result, the state of the hose body 34 is changed from the flexible state to the high-rigidity state. At this time, the joint ring member 42 and the outer hose 30 are brought into close contact with each other via the high friction surface 54 and are frictionally engaged with each other. As a result, the shape (e.g., curved shape) of the shape-variable body 28 is maintained so as not to be deformed, and thus the shape-retaining force of the hose body 34 in the highly rigid state (at the time of curing) is improved. Conversely, when air is introduced into the internal space 36 from the state in which the air is discharged, the shape of the shape-variable body 28 is released, and the hose body 34 is changed from the high-rigidity state (cured state) to the flexible state (uncured state, softened state).

Here, the high friction surface described in the present specification means a surface having a higher friction coefficient than a contact surface where the high friction surface is not formed. The friction coefficient of the high friction surface can be determined by JISP8147: the method described in 2010 or a method based thereon. The friction coefficient of the high friction surface is higher than the outer peripheral surface of the outer hose 30 and the inner peripheral surface of the inner hose 32. The non-deformable state described in the present specification means that the shape of the shape variable body 28 is fixed when the air in the internal space 36 is discharged. The frictional engagement described in the present specification means engagement of the contact surfaces with each other by frictional force. The frictional force is generated when the respective contact surfaces come into contact with each other in the radial direction of the hose body 34 when the hose body 34 is viewed from the axis Ax direction. The contact surfaces are formed in a substantially circular shape when viewed from the axis Ax direction. Hereinafter, a specific example of the high friction surface will be described.

As the high friction surface 54, a resin layer formed by coating a resin on the 1 st contact surface of the joint ring member 42 can be exemplified, and as the resin in this case, for example, a resin such as silicone having a high friction coefficient is preferably used. As the high friction surface 54, a roughened surface formed on the 1 st contact surface, which is formed by performing a roughened surface treatment such as blasting, laser irradiation, chemical conversion treatment, or etching on the 1 st contact surface, can be exemplified. As another embodiment of the high friction surface 54, a method of roughening the surface of the resin layer applied to the 1 st contact surface and a method of roughening the surface of the 1 st contact surface and then applying the roughened surface with a resin can be exemplified.

In the present embodiment, the surface in contact with the inner peripheral surface of the outer hose 30 is exemplified as the 1 st contact surface of the joint ring member 42 provided with the high friction surface 54, but the present invention is not limited to this, and the high friction surface 54 may be provided on the surface in contact with the outer peripheral surface of the inner hose 32 (1 st contact surface). That is, the high friction surface 54 may be provided on a surface that contacts at least one of the outer hose 30 and the inner hose 32. For example, even when the high friction surface 54 is provided on the surface that contacts the inner hose 32, the frictional force between the joint ring member 42 and the inner hose 32 can be increased to increase the shape retention force of the hose body 34 during curing. The high friction surface 54 may be provided on each surface that contacts the outer hose 30 and the inner hose 32. In the present embodiment, the high friction surface 54 is provided on both the fixed ring member 46 and the joint piece 48, but the present invention is not limited to this, and the high friction surface 54 may be provided on at least one of the fixed ring member 46 and the joint piece 48. In addition, when the high friction surface 54 is provided on either the fixing ring member 46 or the joint sheet 48, it is more preferable that the high friction surface 54 is provided on the joint sheet 48, and the shape retention force of the hose body 34 at the time of curing can be improved as compared with the case where the high friction surface 54 is provided on the fixing ring member 46. The high friction surface 54 may be provided on the inner peripheral surface of the outer hose 30 and the surface (the 2 nd contact surface) that contacts the joint ring member 42, or may be provided on the outer peripheral surface of the inner hose 32 and the surface (the 2 nd contact surface) that contacts the joint ring member 42. Further, the present invention may be provided in both the outer hose 30 and the inner hose 32.

Fig. 4 is an explanatory view schematically showing the relative arrangement positions of the joint ring members 42A and 42B shown in fig. 3. An example of the arrangement position of the joint ring members 42A and 42B shown in fig. 3 will be described below with reference to fig. 4.

Here, for the sake of easy understanding of the above-described arrangement position, the joint piece 48 of the joint ring member 42A extending toward the joint ring member 42B side will be referred to as 1 st joint piece a, and the joint piece 48 of the joint ring member 42B extending toward the joint ring member 42A side will be referred to as 2 nd joint piece B. In this case, the positions in the axial Ax direction of the 1 st joint plate end region a on the joint ring member 42B side of the 1 st joint plate a and the 2 nd joint plate end region B on the joint ring member 42A side of the 2 nd joint plate B are arranged at positions overlapping each other and the positions in the circumferential direction C are arranged at positions offset from each other. That is, when the width of the joint ring members 42A, 42B in the axial Ax direction is W1 and the arrangement pitch of the joint ring members 42A, 42B in the axial Ax direction is P, the joint ring members 42A, 42B are arranged so as to satisfy P < W1. The 1 st joint piece a and the 2 nd joint piece B are alternately arranged one by one along the circumferential direction C.

According to the arrangement position shown in fig. 3 and 4, as the hose body 34 is bent, the 1 st joint piece end region a and the 2 nd joint piece end region b on the inner peripheral side where the radius of curvature of the hose body 34 is small are relatively moved in the direction to approach each other, and the 1 st joint piece end region a and the 2 nd joint piece end region b on the outer peripheral side where the radius of curvature of the hose body 34 is large are relatively moved in the direction to separate from each other. Then, as shown in the schematic view of the bent hose body 34 of fig. 5, the shape variable body 28 of fig. 3 is deformed into a bent shape following the bent shape of the hose body 34. When the hose body 34 is cured in this state, the hose body 34 is held in a curved shape, which is the shape at that time. Further, by disposing the joint ring member 42A and the joint ring member 42B along the axis Ax direction as shown in fig. 3, the hose body 34 (in particular, the inner hose 32) is covered with the plurality of joint ring members 42, and thus the hose body 34 can be cured without buckling.

The maximum bending shape of the hose body 34 is defined by flexibility of the hose body 34 itself, a gap between the 1 st joint sheet end region a and the 2 nd joint sheet end region b in the circumferential direction C, and the like. As a result, the hose body 34 is flexibly bent from the straight-bar shape shown in fig. 1 until the maximum bent shape is reached, and the shape thereof can be maintained in the bent shape when the hose body 34 is cured.

On the other hand, as shown in fig. 2, the guide tube 10 has a mesh tube (also referred to as a scraper or a mesh) 56 in the inner space 36 of the hose body 34. As an example, the mesh tube 56 is disposed in the space between the inner tube 32 and the shape variable body 28 in the inner space 36, and covers the outer periphery of the inner tube 32. Buckling of the hose body 34 can also be prevented by the mesh tube 56. The mesh tube 56 is not necessarily required in the guide tube 10, but from the viewpoint of preventing buckling, it is preferable to provide the mesh tube 56.

Next, an example of an operation in the case of guiding the insertion portion 14 of the endoscope 12 to the large intestine by the guide tube 10 will be described with reference to a schematic diagram of the large intestine 500 shown in fig. 6.

As shown in fig. 6, the tube main body 34 of the guide tube 10 is inserted into the large intestine 500 through the anus with the insertion portion 14 penetrating the endoscope 12 inserted. At this time, in the endoscope 12, the distal end hard portion 18 of the insertion portion 14 is preferably inserted into the large intestine 500 in a state of protruding forward from the distal end opening 10A (see fig. 1) of the hose main body 34. Thus, the view of the front side in the insertion direction can be obtained through the illumination window 24 and the observation window 26 of the distal end hard portion 18. While the visual field is thus obtained, the hose body 34 is inserted along the large intestine 500, and the insertion portion 14 penetrating the hose body 34 is inserted. At this time, since the insertion portion 14 and the hose body 34 each have flexibility, they are smoothly inserted along the curved shape of the large intestine 500.

Here, for example, when the endoscope 12 is used to treat the lesion 506 of the transverse colon 504 in a state where the flexible tube main body 34 is bent along the sigmoid colon (part not fixed to the body) 502, the pump 38 (see fig. 1) is operated, and the air in the internal space 36 is sucked from the pipe 40. At this time, the tube main body 34 is deformed into a curved shape following the curved shape of the sigmoid colon 502. As a result, the shape variable body 28 (see fig. 3) constituted by the plurality of joint ring members 42 is deformed into a curved shape following the curved shape of the hose body 34 (i.e., the curved shape of the sigmoid colon).

Then, when the air in the internal space 36 is sucked as described above, the outer hose 30 and the inner hose 32 of the hose body 34 are respectively pressed against the plurality of joint ring members 42 constituting the shape-variable body 28. As a result, each joint ring member 42 is in close contact with the inner hose 32, and the high friction surface 54 of each joint ring member 42 is in close contact with the outer hose 30 to be in frictional engagement therewith. Thereby, the hose body 34 is solidified in a shape corresponding to the curved shape of the sigmoid colon 502, and the shape is maintained, so that the insertability of the insertion portion 14 with respect to the sigmoid colon 502 is improved.

Next, the bending portion 20 of the insertion portion 14 is protruded forward from the distal end opening 10A of the guide tube 10, and a treatment tool (not shown) is guided forward from a treatment tool guide opening (not shown) of the distal end hard portion 18, so that treatment of the lesion 506 of the transverse colon 504 is started. At this time, since the insertion property of the insertion portion 14 with respect to the sigmoid colon 502 is improved by the guide tube 10, the distal end hard portion 18 can be positioned at an accurate treatment position, and as a result, the lesion 506 can be accurately treated.

Fig. 7 is a schematic view of the case where the treatment of the lesion 506 is performed only by the endoscope 12 without using the guide tube 10, and is an explanatory view compared with the treatment of fig. 6. According to the treatment method of fig. 7, even if the insertion portion 14 is pushed into the large intestine 500, the distal end hard portion 18 of the insertion portion 14 is difficult to advance due to the deformation of the sigmoid colon 502, and the positional adjustment of the distal end hard portion 18 becomes difficult. As a result, it is difficult to accurately treat the lesion 506. In contrast, according to the treatment method of fig. 6 in which the guide tube 10 is used in combination for treatment, since the insertion property of the insertion portion 14 with respect to the sigmoid colon 502 is improved by the guide tube 10, the distal end hard portion 18 is easy to advance, and the position of the distal end hard portion 18 is easy to adjust. As a result, the lesion 506 can be accurately treated.

As described above, according to the guide tube 10 according to embodiment 1, the shape-variable body 28 has the plurality of joint ring members 42 arranged along the axial Ax direction of the hose main body 34, each joint ring member 42 has the fixed ring member 46 and the plurality of joint pieces 48, and the 1 st contact surface (the surface that contacts at least one of the outer hose 30 and the inner hose 32) of each joint ring member 42 has the high friction surface 54, so that the shape retention force of the hose main body 34 can be improved while maintaining flexibility. Thus, according to the guide tube 10 of embodiment 1, the insertion performance of the insertion portion 14 of the endoscope 12 can be improved.

Further, since the plurality of joint pieces 48 of each joint ring member 42 are arranged at equal intervals in the circumferential direction C, even shape retention force can be obtained regardless of the direction in which the hose body 34 is bent.

In the present embodiment, the respective joint pieces 48 are shown as being arranged at equal intervals in the circumferential direction C as one of the preferred embodiments, but the present invention is not limited to this, and the respective joint pieces 48 may be arranged at unequal intervals in the circumferential direction C. For example, the arrangement interval of each of the joint sheets 48 in the circumferential direction C may be periodically changed.

Next, several other embodiments related to the guide tube will be described.

Fig. 8 is a schematic diagram showing a configuration of a main part of a shape variable body 28A provided in a guide tube 60 according to embodiment 2. Fig. 8 schematically illustrates the relative arrangement positions of the joint ring members 142A and 142B adjacent to each other in the axial direction of the joint ring members 142 arranged along the axial direction of the axial direction. The same reference numerals are given to the components common to embodiment 1.

Here, embodiment 1 differs from embodiment 2 in that, in the guide tube 10 of embodiment 1, the 1 st joint pieces a and the 2 nd joint pieces B are alternately arranged one by one along the circumferential direction C, and in the guide tube 60 of embodiment 2, a plurality of 1 st joint piece groups D (2 1 st joint piece groups D are illustrated in fig. 8) composed of 2 1 st joint pieces a and a plurality of 2 nd joint piece groups E (1 st joint piece groups E are illustrated in fig. 8) composed of 2 nd joint pieces B are alternately arranged along the circumferential direction C. Other structures are the same, and therefore, description thereof is omitted.

As with the guide tube 10, the guide tube 60 of embodiment 2 also moves the 1 st joint segment group D and the 2 nd joint segment group E on the inner peripheral side of the hose body 34 relatively in the direction approaching each other, and moves the 1 st joint segment group D and the 2 nd joint segment group E on the outer peripheral side of the hose body 34 relatively in the direction separating from each other as the hose body 34 (see fig. 2) is bent. Further, by curing the hose body 34 in a state where the hose body 34 is bent, the hose body 34 can be held in a bent shape.

Therefore, the guide tube 60 of embodiment 2 can also improve the shape retention force of the hose body 34 while maintaining flexibility, and thus can improve the insertion property of the insertion portion 14 of the endoscope 12, as in the guide tube 10.

In embodiment 2, the 1 st joint group D is constituted by 2 1 st joint pieces a and the 2 nd joint group E is constituted by 2 nd joint pieces B, but the present invention is not limited to this, and the 1 st joint group D and the 2 nd joint group E may be constituted by 3 or more 1 st joint pieces a and 2 nd joint pieces B, respectively. Further, the 1 st joint segment group D and the 2 nd joint segment group E are preferably formed at equal intervals in the circumferential direction C, and as a result, even shape retention force can be obtained regardless of the direction in which the hose body 34 is bent.

Fig. 9 is a schematic diagram showing a configuration of a main part of the shape-variable body 28B provided in the guide tube 70 according to embodiment 3. Fig. 9 schematically illustrates the relative arrangement positions of the joint ring members 242A and 242B adjacent to each other in the axial direction of the joint ring members 242 arranged along the axial direction of the axial direction. The same reference numerals are given to the components common to embodiment 1.

Here, embodiment 1 differs from embodiment 3 in that in the guide tube 10 of embodiment 1, the positions in the axial Ax direction of the 1 st joint piece end region a and the 2 nd joint piece end region B are arranged at positions overlapping each other, and in the guide tube 70 of embodiment 3, the positions in the axial Ax direction of the 1 st joint piece a and the 2 nd joint piece B are arranged at positions offset from each other. That is, when the width of the joint ring members 242A, 242B in the axial Ax direction is W1 and the arrangement pitch of the joint ring members 242A, 242B in the axial Ax direction is P, the joint ring members 242A, 242B in the guide tube 70 are arranged so as to satisfy P > W1. In addition, p=w1 may be also configured to be satisfied. Other structures are the same, and therefore, description thereof is omitted.

As with the guide tube 10, the guide tube 70 of embodiment 3 also moves the 1 st and 2 nd joint blade end regions a and b on the inner peripheral side of the hose body 34 relatively in the direction to approach each other, and moves the 1 st and 2 nd joint blade end regions a and b on the outer peripheral side of the hose body 34 relatively in the direction to separate from each other as the hose body 34 (see fig. 2) is bent. Further, by curing the hose body 34 in a state where the hose body 34 is bent, the hose body 34 can be held in a bent shape.

Therefore, the guide tube 70 of embodiment 3 can also improve the shape retention force of the hose body 34 while maintaining flexibility, and thus can improve the insertion property of the insertion portion 14 of the endoscope 12, as in the guide tube 10.

Fig. 10 is a schematic diagram showing a configuration of a main part of a shape variable body 28C provided in a guide tube 80 according to embodiment 4. Fig. 10 schematically illustrates the relative arrangement positions of the joint ring members 342A, 342B adjacent to each other in the axial direction of the joint ring members 342 arranged along the axial direction of the axial direction. The same reference numerals are given to the components common to embodiment 3.

Here, embodiment 3 is different from embodiment 4 in that, in the guide tube 70 of embodiment 3, the intervals between the 1 st joint piece a and the 2 nd joint piece B in the circumferential direction C are wide, whereas, in the guide tube 80 of embodiment 4, the intervals between the 1 st joint piece a and the 2 nd joint piece B in the circumferential direction C are narrow, and the positions of the 1 st joint piece end region a and the 2 nd joint piece end region B in the circumferential direction C are arranged at positions overlapping each other. Other structures are the same, and therefore, description thereof is omitted.

The guide tube 80 of embodiment 4 thus constructed can improve the shape retention force of the hose body 34 while maintaining flexibility, as in the guide tube 70, and thus can improve the insertion property of the insertion portion 14 of the endoscope 12.

Fig. 11 is a schematic diagram showing a configuration of a main part of a shape variable body 28D provided in a guide tube 90 according to embodiment 5. Fig. 11 schematically illustrates the relative arrangement positions of the joint ring members 442A and 442B adjacent to each other in the axial direction of the joint ring members 442 arranged along the axial direction of the axial direction. The same reference numerals are given to the components common to embodiment 4.

Here, embodiment 4 differs from embodiment 5 in that in the guide tube 80 of embodiment 4, the plurality of joint pieces 48 extend from the fixed ring member 46 to both sides in the axial Ax direction, whereas in the guide tube 90 of embodiment 5, the plurality of joint pieces 48 of the respective joint ring members 442A, 442B extend from the fixed ring member 46 to only one side in the axial Ax direction (left side in fig. 11). Other structures are the same, and therefore, description thereof is omitted. The width (W2) of the guide tube 90 is smaller than the width (W1) of the guide tube 80 extending to both sides of the joint sheet 48, but is arranged so as to satisfy P > W2 in the same manner as the guide tube 80.

According to the guide tube 90 of embodiment 5, as the hose body 34 (refer to fig. 2) is bent, the fixed ring member 46 of the joint ring member 442A and the joint sheet 48 of the joint ring member 442B located on the inner peripheral side of the hose body 34 relatively move in the direction to approach each other, and the fixed ring member 46 of the joint ring member 442A and the joint sheet 48 of the joint ring member 442B located on the outer peripheral side of the hose body 34 relatively move in the direction to separate from each other. Further, by curing the hose body 34 in a state where the hose body 34 is bent, the hose body 34 can be held in a bent shape.

Accordingly, the guide tube 90 according to embodiment 5 can improve the shape retention force of the hose body 34 while maintaining flexibility, and thus can improve the insertion property of the insertion portion 14 of the endoscope 12, similarly to the guide tube 80.

Fig. 12 is a schematic diagram showing a configuration of a main part of a shape variable body 28E provided in a guide tube 100 according to embodiment 6.

The embodiments 1 to 5 are different from the embodiment 6 in that, in the guide tube 10, 60, 70, 80, 90 of the embodiments 1 to 5, the joint ring members 42, 142, 242, 342, 442 are used as the shape-variable members 28, 28A to 28D, and in the guide tube 100 of the embodiment 6, the spiral tube 104 is used as the shape-variable member 28E. Other structures are the same, and therefore, description thereof is omitted.

The spiral pipe 104 is formed by winding a band member 106 in a spiral shape, and is disposed on the outer peripheral side of an inner hose (refer to fig. 2). The spiral pipe 104 has a high friction surface 54 on a surface (1 st contact surface) that contacts at least one of the outer hose 30 and the inner hose 32 shown in fig. 2 (the outer hose 30 in fig. 12). Accordingly, when the air in the internal space 36 is discharged by the pump 38 (see fig. 1), the spiral pipe 104 and the outer hose 30 are brought into close contact with each other via the high friction surface 54 in the hose body 34 (see fig. 2) of the guide pipe 100. As a result, the shape of the coil pipe 104 is maintained so as not to be deformed, and thus the shape maintaining force of the hose body 34 in the high-rigidity state (at the time of curing) is improved. Further, since the spiral tube 104 has flexibility in the bending direction, the shape can be deformed into a curved shape as shown in fig. 13, for example.

Next, an example of an operation in the case of guiding the insertion portion 14 of the endoscope 12 to the large intestine 500 (see fig. 6) by the guide tube 100 will be described.

First, when the hose body 34 is inserted along the large intestine 500 and the insertion portion 14 penetrating the hose body 34 is inserted, the insertion portion 14, the hose body 34, and the spiral tube 104 have flexibility, so that the insertion portion is smoothly inserted along the curved shape of the large intestine 500.

Next, when the pump 38 is operated in a state where the hose body 34 is made to follow the curved shape of the sigmoid colon 502, and air in the internal space 36 is sucked from the pipe 40, the outer hose 30 and the inner hose 32 are pressed against the spiral pipe 104. As a result, the spiral tube 104 is in close contact with the inner hose 32, and the high friction surface 54 of the spiral tube 104 is in close contact with the outer hose 30 to be in friction engagement therewith. Thereby, the hose body 34 is solidified in a shape corresponding to the curved shape of the sigmoid colon 502, and the shape is maintained, so that the insertability of the insertion portion 14 with respect to the sigmoid colon 502 is improved.

Next, the bending portion 20 of the insertion portion 14 is protruded forward from the distal end opening 10A of the guide tube 100, and a treatment tool (not shown) is guided forward from a treatment tool guiding port (not shown) of the distal end hard portion 18, so that treatment of the lesion 506 of the transverse colon 504 is started. At this time, since the insertion property of the insertion portion 14 with respect to the sigmoid colon 502 is improved by the guide tube 100, the distal end hard portion 18 can be positioned at an accurate treatment position, and as a result, the lesion 506 can be accurately treated.

As described above, according to the guide tube 100 of embodiment 6, the shape-variable member 102 has the spiral tube 104, and the spiral tube 104 has the high friction surface 54, so that the shape retention force of the hose body 34 can be improved while maintaining flexibility. Thus, according to guide tube 100 of embodiment 6, the insertion performance of insertion portion 14 of endoscope 12 can be improved. In embodiment 6, the high friction surface 54 may be provided on the surface of the spiral pipe 104 that is in contact with the inner hose 32, or the high friction surface 54 may be provided on at least one of the outer hose 30 and the inner hose 32.

Fig. 14 is an enlarged cross-sectional view showing the structure of a guide tube 600 according to embodiment 7. In fig. 14, a portion of the guide tube 600 in the axial Ax direction is cut out. Fig. 15 is a schematic cross-sectional view of the guide tube 600 taken along the line XV-XV in fig. 14. The same reference numerals are given to the components common to the guide tube 10 of embodiment 1.

As shown in fig. 14 and 15, the guide tube 600 has a hose body 606 having a double tube structure, and the hose body 606 has a flexible outer hose 602 and a flexible inner hose 604 disposed inside the outer hose 602. The outer tube 602 and the inner tube 604 are each made of, for example, a soft resin material capable of being bent along a bending portion of the intestinal tract. As the soft resin material, urethane (urethane resin) can be exemplified. However, the present invention is not limited to this, and any material having an elastic modulus of about 5 to 20MPa at 100% elongation, which is obtained by the method described in jis k7161 (tensile test) or a method based thereon, can be applied as the outer hose 602 and the inner hose 604. Further, as an example, the thicknesses of the outer tube 602 and the inner tube 604 are about 100 μm to 200 μm, respectively, and the total thickness of the outer tube 602 and the inner tube 604 is about 200 μm to 400 μm. In addition, from the viewpoint of preventing breakage, the thickness of the outer hose 602 is preferably made thicker than the inner hose 604.

For example, when the thickness T of the hose body 606 shown in fig. 15 is about 1mm (for example, 1mm at maximum), the thickness of the internal space 608 between the outer hose 602 and the inner hose 604 is about 600 μm to 800 μm. The thickness of each of the outer tube 602, the inner tube 604, and the inner space 608 is not limited to the above thickness, and is set according to the diameter of the insertion portion 14 (see fig. 1), the diameter of the insertion path of the object into which the insertion portion 14 is inserted, and the like. The inner diameter of the inner hose 604 is also set according to the diameter of the insertion portion 14, and is, for example, about 6mm to 16 mm.

The outer circumferential surface of the outer hose 602 and the inner circumferential surface of the inner hose 604 have hydrophilic coatings 610, respectively. By forming the hydrophilic coating 610 on the outer peripheral surface of the outer hose 602, frictional resistance between the outer hose 602 and the large intestine 500 (refer to fig. 6) can be reduced. As a result, the insertion (advancing) of the hose body 606 with respect to the large intestine 500 is improved. Further, by forming the hydrophilic coating 610 on the inner peripheral surface of the inner hose 604, frictional resistance between the inner hose 604 and the insertion portion 14 (refer to fig. 1) can be reduced. As a result, the insertion property of the insertion portion 14 with respect to the hose body 606 is improved. In this example, the case where the hydrophilic coating 610 is formed on both the outer tube 602 and the inner tube 604 has been described as an example, but the present invention is not limited thereto, and the hydrophilic coating 610 may be formed on at least one of the outer tube 602 and the inner tube 604. However, the hydrophilic coating 610 is preferably formed on both the outer hose 602 and the inner hose 604, since the above 2 effects can be obtained at the same time.

The inner space 608 is a space formed in an annular shape (ring shape) so as to surround the periphery (outer periphery) of the inner tube 604 in a cross-sectional shape perpendicular to the axis Ax of the guide tube 600, and a shape variable 612 and an intermediate layer 614, which will be described later, are disposed.

As shown in fig. 14, ring-shaped caps 616 and 618 are bonded to the proximal end side and the distal end side of the hose body 606, respectively, and the outer hose 602 and the inner hose 604 are sealed by the caps 616 and 618. As a result, the internal space 608 is formed as a closed space. A pump 38 for supplying fluid (e.g., air) to the internal space 608 and discharging fluid from the internal space 608 is connected to the cap 616 on the base end side of the hose body 606 via the pipe 40.

Fig. 16 is an enlarged cross-sectional view of a main portion of the proximal end side of the guide tube 600 shown in fig. 14. As shown in fig. 16, the cap 616 on the base end side of the hose body 606 is bonded to the base end side of the outer hose 602 via an adhesive 620 and to the base end side of the inner hose 604 via an adhesive 622. The base end sides of the shape-variable body 612 and the intermediate layer 614 are bonded to the cover 616 by an adhesive 622.

Fig. 17 is an enlarged cross-sectional view of a main portion of the distal end side of the guide tube 600 shown in fig. 14. As shown in fig. 17, the cap 618 on the front end side of the hose main body 606 is adhered to the front end side of the outer hose 602 via an adhesive 624 and to the front end side of the inner hose 604 via an adhesive 626. The base end sides of the shape-variable body 612 and the intermediate layer 614 are bonded to the cover 618 by an adhesive 626.

Referring back to fig. 16, the lid 616 on the base end side has a vent hole 628 that communicates the internal space 608 and the pipe 40. The piping 40 is connected to the pump 38 via a three-way cock 630. The three-way cock 630 has a 1 st port 630A connected to the pump 38, a 2 nd port 630B connected to the pipe 40, and a 3 rd port 630C open to the atmosphere. The three-way cock 630 has a cock 632 as an example of the switching member of the present invention. By operating the cock 632 by the medical practitioner, the ON mode in which the 1 st port 630A and the 2 nd port 630B are communicated and the OFF mode in which the 1 st port 630A and the 3 rd port 630C are communicated can be selectively switched. When the cock 632 is switched to the ON mode, the pump 38 and the internal space 608 communicate with each other. As a result, the air in the internal space 608 is sucked by the pump 38, and the atmosphere is opened or the air (atmosphere) is supplied (flowed) to the internal space 608 by the pump 38. When the cock 632 is switched to the OFF mode, the pump 38 communicates with the outside air. As a result, the supply and discharge of air to and from the internal space 608 is stopped. The switching operation by the three-way cock 630 is performed while the pump 38 is continuously operated, but instead of this, the switching operation may be performed by starting (ON) and stopping (OFF) the pump 38. In this case, the ON and OFF operations of the pump 38 can be operated by a foot switch (not shown) as another example of the switching means of the present invention. Further, an operation button (not shown) for performing ON and OFF operations of the pump 38 may be provided in the hand-held operation unit 16 of the endoscope 12 (see fig. 1). The operation button is an example of the switching means of the present invention.

Next, a shape variable body 612 shown in fig. 14 and 15 will be described. A shape variable 612 is disposed between the outer hose 602 and the inner hose 604 (i.e., the interior space 608). The shape variable body 612 is deformable in accordance with the shape of the hose body 606, and has a spiral pipe 640 arranged along the axis Ax direction of the hose body 606.

Fig. 18 is an external view of the spiral tube 640. As shown in fig. 18, the spiral pipe 640 is formed by winding a band-shaped member 642 in a spiral shape, and is disposed on the outer peripheral side of the inner hose 604 (see fig. 14). The spiral tube 640 has a high friction surface 644 on a surface (outer peripheral surface, 1 st contact surface) that contacts an intermediate layer 614 (see fig. 14) described later. Accordingly, when air in the internal space 608 (see fig. 14) is discharged by the pump 38 (see fig. 14), the spiral tube 640 and the intermediate layer 614 are brought into close contact with each other via the high friction surface 644 in the hose body 606 (see fig. 14). As a result, the shape (e.g., curved shape) of the spiral tube 640 is maintained so as not to be deformed, and thus the shape retention force of the hose body 606 in the high-rigidity state (at the time of curing) is improved. Further, since the spiral tube 640 has flexibility in the bending direction, the shape can be deformed into a curved shape as shown in fig. 19, for example.

For example, the band-shaped member 642 of the spiral pipe 640 is made of stainless steel (SUS: steel Use Stainless). However, the present invention is not limited to this, and any material (for example, plastic) that can deform in conformity with the shape of the hose body 606 may be applied. For example, when the thickness T (see fig. 15) of the hose body 606 is about 1mm (for example, 1mm at maximum), the thickness of the band-like member 642 is preferably 300 μm or less. As the high friction surface 644, a resin layer formed by coating the outer peripheral surface (1 st contact surface) of the spiral pipe 640 with a resin such as a urethane coating or a silica coating, a roughened surface formed on the 1 st contact surface, or a resin layer formed by coating the roughened surface formed on the 1 st contact surface with a resin can be exemplified. In forming the resin layer, the spiral pipe 640 can be formed by immersing the entire spiral pipe in a molten resin and drying the same. In this case, a resin layer is formed on the surface (inner peripheral surface) of the spiral pipe 640 that contacts the inner hose 604, as a high friction surface.

When the high friction surface is formed on the inner peripheral surface of the spiral pipe 640 as described above, the spiral pipe 640 and the inner hose 604 are brought into close contact with each other via the high friction surface to be frictionally engaged. In the case where the high friction surface is also formed on the outer peripheral surface of the inner hose 604, the spiral pipe 640 and the inner hose 604 are brought into close contact with each other via the high friction surfaces, thereby friction-engaging each other. In either case, the shape retention of the hose body 606 is further improved. As shown in fig. 16 and 17, the 2 wound portions on the base end side and the tip end side of the spiral tube 640 configured as described above are bonded to the base end side and the tip end side of the inner hose 604 by the adhesives 622 and 626, respectively. As a result, the helical tube 640 is firmly bonded to the inner hose 604.

Next, the intermediate layer 614 shown in fig. 14 will be described. The intermediate layer 614 is a sheet 650 disposed between the outer hose 602 and the inner hose 604 and capable of contacting the shape-variable body 612 (spiral tube 640). As an example, the sheet 650 is disposed between the outer hose 602 and the spiral tube 640.

Fig. 20 is a perspective view of a sheet 650. As shown in fig. 20, the sheet 650 is formed in a cylindrical shape and is disposed along the axis Ax direction of the hose body 606 (refer to fig. 14). Thereby, the outer peripheral surface (1 st contact surface) of the spiral tube 640 (fig. 18) is covered with the sheet 650. The sheet 650 has flexibility capable of deforming in conformity with the shape of the hose body 606 (see fig. 14). Specifically, the sheet 650 has flexibility and a higher elastic modulus than the outer hose 602 (see fig. 14) and the inner hose 604. The elastic modulus will be described later.

For example, as shown in a front view of a sheet 650 in fig. 21, the sheet 650 is configured by bending one rectangular sheet 652 into a cylindrical shape and bonding two edge portions that are abutted with each other with an adhesive 654. The shape of the sheet 650 is not limited to a cylindrical shape, and may be, for example, a shape in which the sheet 652 is bent in a C-shape or a shape in which a plurality of long sheets are interposed between the outer hose 602 and the spiral pipe 130. In this example, the sheet 650 is exemplified as the intermediate layer 614, but the present invention is not limited thereto, and a mesh-like or wire-like member can be applied as long as the sheet is in contact with the shape-variable body 612 (spiral pipe 640). Hereinafter, a sheet 650 applied as the intermediate layer 614 will be described.

For example, the sheet 650 is made of resin such as urethane. However, the present invention is not limited thereto, and for example, an aluminum vapor deposition film can be applied. The aluminum vapor deposition film is formed by vacuum vapor deposition (thermocompression bonding) of aluminum (aluminum foil) on the surface of the base film. By applying an aluminum vapor deposited film as the sheet 650, the rigidity of the sheet 650 can be improved. In this case, examples of the base film include films having heat sealability such as PET (polyethylene terephthalate ) and PE (polyethylene). The elastic modulus of the sheet 650 obtained by the method described in JISK7161 (tensile test) or the method based thereon is preferably higher than that of the outer hose 602 and the inner hose 604. Thereby, the outer hose 602 and the inner hose 604 can be reinforced by the sheet 650. That is, the tensile strength and tensile rigidity of the hose body 606 are improved by the sheet 650. As a result, the forward movement of the hose body 606 is improved when the hose body 606 is not cured (when in a flexible state). The material having the optimal elastic modulus can be selected by using an aluminum vapor deposited film or a material obtained by combining various cloths and films with an aluminum foil.

For example, when the thickness of the hose body 606 is about 1mm (for example, 1mm at maximum), the thickness of the sheet 650 is preferably 300 μm or less. However, from the viewpoint of rigidity, it is preferable that the thickness of the outer tube 602 and the inner tube 604 is thicker. When an aluminum vapor deposition film is applied to the sheet 650, the rigidity of the sheet 650 can be changed by changing the base film. As a result, the hardness of the hose body 606 in the non-curing state can be adjusted to a hardness suitable for the lower digestive tract such as the large intestine or the upper digestive tract such as the esophagus.

As shown in fig. 20, the sheet 650 has a high friction surface 656 on a surface (inner peripheral surface, 2 nd contact surface) that contacts the spiral pipe 640 (see fig. 17). Accordingly, when air in the internal space 608 (see fig. 14) is discharged by the pump 38, the spiral tube 640 (see fig. 17) and the sheet 650 are brought into close contact with each other via the high friction surfaces 644 and 656 in the hose body 606 (see fig. 14). As a result, the shape (e.g., curved shape) of the spiral tube 640 is kept undeformable, and thus the shape retention force of the hose body 606 in the highly rigid state (at the time of curing) is further improved.

In this example, the high friction surfaces 644 and 656 are formed on both the 1 st contact surface (outer peripheral surface) of the spiral pipe 640 and the 2 nd contact surface (inner peripheral surface) of the sheet 650, but the high friction surfaces may be formed on either contact surface or may be formed only on the 2 nd contact surface (inner peripheral surface) of the sheet 650. The high friction surface is preferably formed on the entire surface of any one of the contact surfaces, but the present invention is not limited to this, and may be formed on a part of any one of the contact surfaces. That is, the high friction surface may be formed on at least a portion of either of the contact surfaces. However, by forming the high friction surfaces 644, 656 on both contact surfaces (preferably, the entire contact surfaces), the shape retention of the hose body 606 is improved. The method of forming the high friction surface 656 is similar to that of the high friction surface 644. Further, from the viewpoint of ensuring flexibility of the hose body 606 in the non-cured state, the gap between the spiral tube 640 and the sheet 650 is preferably about 50 μm to 500 μm.

Further, the high friction surface may be formed on at least a part of the outer peripheral surface of the sheet 650 (preferably the entire outer peripheral surface of the sheet 650). As a result, the sheet 650 and the outer hose 602 are brought into frictional engagement with each other via the high friction surface. The high friction surface may be formed on at least a part of the inner peripheral surface of the outer hose 602 (preferably, the entire inner peripheral surface of the outer hose 602). As a result, the sheet 650 and the outer hose 602 are brought into close contact with each other via the respective high friction surfaces, thereby friction-engaging each other. In either case, the shape retention of the hose body 606 is further improved.

Next, an example of an operation in the case of guiding the insertion portion 14 of the endoscope 12 to the large intestine 500 (see fig. 6) by the guide tube 600 will be described.

First, when the hose body 606 and the insertion portion 14 (see fig. 1) penetrating the hose body 606 are inserted along the large intestine 500 (see fig. 6), the insertion portion 14, the hose body 606, the spiral tube 640, and the sheet 650 have flexibility, respectively, so that they are smoothly inserted along the curved shape of the large intestine 500.

Next, when the pump 38 is operated with the hose body 606 being brought along the curved shape of the sigmoid colon 502, and air in the internal space 608 is sucked from the pipe 40, the outer hose 602 is pressed against the sheet 650 and the inner hose 604 is pressed against the spiral pipe 640. As a result, the high friction surface 644 of the spiral tube 640 is in close contact with the high friction surface 656 of the sheet 650 and frictionally engages therewith. Thereby, the hose body 606 is solidified in a shape corresponding to the curved shape of the sigmoid colon 502, and the shape is maintained, so that the insertability of the insertion portion 14 with respect to the sigmoid colon 502 is improved. In the above-described operation example, the hose body 606 is cured in a shape corresponding to the curved shape of the sigmoid colon 502, but the present invention is not limited to this operation example. For example, as another operation example, the tube main body 606 may be cured in a state where the sigmoid colon 502 is substantially linear.

Next, the bending portion 20 of the insertion portion 14 is protruded forward from the distal end opening 10A of the guide tube 100, and a treatment tool (not shown) is guided forward from a treatment tool guiding port (not shown) of the distal end hard portion 18, so that treatment of the lesion 506 of the transverse colon 504 is started. At this time, since the insertion property of the insertion portion 14 with respect to the sigmoid colon 502 is improved by the guide tube 600, the distal end hard portion 18 can be positioned at an accurate treatment position, and as a result, the lesion 506 can be accurately treated.

As described above, according to guide tube 600 of embodiment 7, since variable shape 612 capable of deforming in accordance with the shape of tube main body 606 is provided between outer tube 602 and inner tube 604, the insertion performance of insertion portion 14 of endoscope 12 can be improved.

Further, the guide tube 600 according to the present embodiment has the following advantages because the spiral tube 640 and the sheet 650 are disposed in the internal space 608 between the outer hose 602 and the inner hose 604. That is, the hardness of the hose body 606 at the time of curing becomes harder than the structure having only the spiral tube 640 (i.e., the structure having no sheet 650) among the spiral tube 640 and the sheet 650. As a result, the insertability of the insertion portion 14 is further improved. In the case of a structure without the sheet 650, when the hose body 606 is inserted into the large intestine 500 and the coil 640 is extended and contracted in the axial Ax direction, the advancing property of the hose body 606 may be affected, but according to the guide tube 600 of the present embodiment, the extension and contraction operation can be suppressed by the frictional force between the coil 640 and the sheet 650. As a result, the forward progress of the hose body 606 in the non-cured state is further improved.

The guide tube 600 of the present embodiment is preferably provided with a mesh tube 56 as shown in fig. 2. Buckling of the hose body 606 can be prevented by the mesh tube 56.

In the above-described operation example, the treatment of the lesion 506 is performed in a state where the tube main body 606 inserted into the large intestine 500 is set to the cured state only 1 time, but the operation example is not limited thereto. For example, the operation may be performed such that the tube main body 606 inserted into the large intestine 500 is changed between the uncured state and the cured state a plurality of times, and the insertion portion 14 and the tube main body 606 are advanced in stages to treat the lesion 506. The operations at this time include: a step of inserting the insertion portion 14 into the large intestine 500 (insertion portion insertion step); a step of inserting the hose body 606 into the large intestine 500 with respect to the insertion portion 14 in a state in which the hose body 606 into which the insertion portion 14 is inserted is in a non-cured state (hose body insertion step); a step of relatively advancing the insertion portion 14 with respect to the hose body 606 in a state where the hose body 606 into which the insertion portion 14 is inserted is set in a cured state (insertion portion advancing step); and a step of relatively advancing the hose body 606 with respect to the insertion portion 14 in a state where the hose body 606 into which the insertion portion 14 is inserted is in a non-cured state (hose body advancing step). The present invention also includes a step (treatment step) of performing treatment of the lesion 506 by bringing the distal end hard portion 18 close to the lesion 506 by repeating the insertion portion advancing step and the hose body advancing step a plurality of times. In such an operation, since the insertion portion 14 has an effective length longer than the total length of the hose body 606 by 300mm or more, as will be described later, the operator can reliably grasp the soft portion 22 and perform the insertion operation without being obstructed by the hose body 606.

Next, several modifications of the spiral duct 640 as the shape-variable body 612 will be described. Fig. 22 to 26 show side views of spiral pipes 700, 710, 720, 730, and 740 as modifications of spiral pipe 640.

Here, the rigidity and flexibility of the spiral pipe depend on the material, thickness t, and bandwidth f of the belt-like member constituting the spiral pipe. As an example, when the material is stainless steel, the thickness t is about 200 μm to 300 μm, and the bandwidth f is about 2mm to 4mm, the initial rigidity and flexibility required for the spiral pipe can be ensured. The maximum curvature when bending the spiral pipe depends on the winding pitch (pitch) p of the belt member. Therefore, as for the spiral pipe 700 of the 1 st modification shown in fig. 22, the spiral pipe 710 of the 2 nd modification shown in fig. 23, and the spiral pipe 720 of the 3 rd modification shown in fig. 24, the band members 702, 712, 722 of the spiral pipes 700, 710, 720 are respectively made of stainless steel, and the preferable thickness t and the bandwidth f are satisfied. Further, since the winding pitch p of the spiral tube 700 is longer than the other spiral tubes 710 and 720 (p > p1> p 2), the spiral tube 700 can be suitably used as a guide tube for a lower gastrointestinal endoscope requiring a large curvature. In contrast, since the winding pitches p1 and p2 of the spiral pipes 710 and 720 are smaller than those of the spiral pipe 700, the spiral pipe can be used as a guide tube for an upper gastrointestinal endoscope that can be used even with a small curvature.

On the other hand, the respective belt members 732, 742 of the spiral pipe 730 of the 4 th modification shown in fig. 25 and the spiral pipe 740 of the 5 th modification shown in fig. 26 are made of stainless steel, and satisfy the above-mentioned preferable thickness t and the bandwidth f, and the respective winding pitches p3 are equal. Therefore, when the spiral pipes 730 and 740 are observed, the belt-shaped member 732 of the spiral pipe 730 has bending portions 734 and 736 which are alternately bent toward the base end side and the tip end side of the axis Ax. In contrast, the belt-like member 742 of the spiral tube 740 has protrusions 744, 746 protruding alternately toward the base end side and the tip end side of the shaft Ax. According to the spiral tube 730 having the bent portions 734, 736 and the spiral tube 740 having the protruding portions 744, 746, the contact area with the sheet can be increased as compared with a spiral tube in which an elongated belt-like member is simply wound into a spiral shape. As a result, the shape retention of the hose body in the high-rigidity state (at the time of curing) can be further improved.

In addition, in the guide tube 600 of embodiment 7, the configuration in which the intermediate layer 614 is disposed between the outer tube 602 and the shape variable member 612 has been described as an example, but the present invention is not limited thereto. For example, as shown in fig. 27, in a longitudinal section of the guide tube 750 according to embodiment 8, an intermediate layer 614 may be disposed between the inner tube 604 and the shape variable member 612. However, from the viewpoint of the assembling property of the guide tube 600, for example, as shown in fig. 14, the intermediate layer 614 is preferably disposed in a wider space between the outer hose 602 and the shape-variable body 612 than in a narrow space between the inner hose 604 and the shape-variable body 612.

In addition, the guide tube 600 of embodiment 7 has been described by taking the configuration having the shape-variable body 612 (spiral tube 640) and the intermediate layer 614 as an example, but the present invention is not limited thereto. For example, it is also possible to apply a guide tube in which a structure having the shape-variable body 28 of the joint ring member 42 (refer to fig. 2) is assembled in the structure of the guide tube 600. In this case, the shape variable body 28 may be disposed between the outer hose 602 and the intermediate layer 614, between the inner hose 604 and the shape variable body 612, or between the shape variable body 612 and the intermediate layer 614.

In the above-described embodiments 1 to 8, examples have been shown in which the hose body 34, 606 is switched to the flexible state and the high-rigidity state by supplying and discharging air to and from the internal space 36, 608, but in the guide device for a medical instrument of the present invention, the hardness of the hose body in the flexible state (initially) and the high-rigidity state (at the time of curing) can be adjusted by changing the materials of the joint ring member and the spiral tube. For example, when the joint ring member and the spiral pipe are made of polypropylene resin, the hardness can be adjusted by using glass fibers contained in the polypropylene resin as short fibers having a short fiber length or long fibers having a long fiber length. In this case, the former has a hardness harder than the latter. Since the hardness of the hose body can be adjusted by changing the material in this way, a guide tube having a hardness corresponding to the application technology can be prepared for each application technology.

An example of the preferred dimensions of the insertion portion 14 and the hose body 34, 606 (see fig. 14) of the endoscope 12 shown in fig. 1 will be described below. First, the inner diameter of the hose body 34, 606 and the outer diameter of the insertion portion 14 are preferably sized so that a gap is formed between the hose body 34, 606 and the insertion portion 14 in a state where the insertion portion 14 is inserted into the hose body 34, 606. That is, when the inner diameter of the hose body 34, 606 is D1 and the outer diameter of the insertion portion 14 is D2, D1 and D2 preferably have a relationship of D1> D2. The gap is more preferably 4mm or less, and still more preferably 1mm or more and 4mm or less.

In the specific dimensional example, when the outer diameter of the insertion portion 14 is 8mm, for example, the inner diameter of the hose body 34, 606 is more preferably 12mm or less, and still more preferably 9mm or more and 12mm or less. When the outer diameter of the insertion portion 14 is, for example, 13mm, the inner diameter of the hose body 34, 606 is more preferably 17mm or less, and still more preferably 14mm or more and 17mm or less.

By setting the above-mentioned gap to 4mm or less in this way, it is possible to prevent the internal tissue (for example, the intestinal wall) from being pinched into the gap between the hose main body 34, 606 and the insertion portion 14. In particular, in the step of relatively advancing the hose body 34, 606 with respect to the insertion portion 14 (hose body advancing step) in a state where the hose body 34, 606 is brought into the uncured state, it is possible to prevent the internal tissue (for example, the intestinal wall) from being pinched into the gap. Further, by setting the gap to 1mm or more, the insertion portion 14 can smoothly advance and retreat with respect to the hose body 34, 606.

Next, a relationship between the length of the insertion portion 14 and the length of the hose body 34, 606 will be described, and the insertion portion 14 preferably has an effective length that is 300mm or more longer than the total length of the hose body 34, 606. Here, the effective length of the insertion portion 14 is a length from the base end to the tip end of the insertion portion 14.

To illustrate a specific example of the dimensions, when the total length of the hose main bodies 34, 606 is 400mm, for example, the insertion portion 14 preferably has an effective length of 700mm or more. When the total length of the hose body 34, 606 is 700mm, for example, the insertion portion 14 preferably has an effective length of 1000mm or more.

By making the effective length of the insertion portion 14 longer than the total length of the hose main body 34, 606 by 300mm or more in this way, the operator can reliably grasp the soft portion 22 and perform the insertion operation without being obstructed by the hose main body 34, 606 during the operation of inserting the hose main body 34, 606 and the insertion portion 14 into the body cavity. Further, as an example, the effective length of the insertion portion 14 is 1200mm. The hose body 34, 606 having a total length of 400mm can be used for large intestine examination, and the hose body 34, 606 having a total length of 700mm can be used for large intestine and small intestine examination.

Fig. 28 is a perspective view of an endoscope apparatus 800 according to embodiment 2 of the present invention.

As shown in fig. 28, a guide tube suitable for use in an endoscope apparatus 800 is formed by attaching a balloon 802 to the guide tube 600 according to embodiment 7 shown in fig. 14. The endoscope applied to the endoscope apparatus 800 is formed by attaching the balloon 804 to the insertion portion 14 of the endoscope 12 shown in fig. 1. The balloon 802 is an example of an internal sealing portion of the present invention, and is an example of a balloon for a hose body of the present invention. The balloon 804 is an example of the balloon for an insertion portion according to the present invention. In this example, the guide tube in which the balloon 802 is attached to the guide tube 600 is described as an example, but the present invention is not limited thereto, and the guide tube in which the balloon 802 is attached to the guide tubes 10, 60, 70, 80, 90, 100 and 750 of embodiments 1 to 6 can be applied.

Fig. 29 is a main part sectional view of the guide tube 600 into which the insertion portion 14 is inserted. Since the detailed structure of the guide tube 600 has been described in fig. 14, the detailed structure of the guide tube 600 is not illustrated in fig. 29, and the description thereof is omitted.

As shown in fig. 28 and 29, a balloon 802 that is freely inflatable and deflatable is detachably attached to the distal end portion of the hose body 606 of the guide tube 600. The balloon 802 is made of an elastic body such as rubber, and includes a central bulge portion 802A and attachment portions 802B and 802B at both ends thereof. The wire 806 is wound around each of the mounting portions 802B and is fixed to the outer surface of the hose body 606.

As shown in fig. 29, an air hose 808 is attached to the outer surface of the hose body 606 along the axis Ax, and the tip of the air hose 808 is opened in the bulge portion 802A to form an air supply suction port 810. The base end of the air hose 808 is connected to a pump 812 disposed outside the hose body 606. The pump 812 is a multifunctional air pump capable of supplying (pressurizing) and sucking air. When air is supplied from the pump 812 to the air hose 808, air is blown out from the air supply suction port 810, and the bulge portion 802A expands. On the other hand, when air is sucked from the pump 812, air is sucked from the air supply suction port 810 through the air hose 808, and the bulge portion 802A contracts.

Here, the pump 38 shown in fig. 14 is connected to the hose body 606 via the pipe 40, but the pump 812 shown in fig. 29 may be used instead of the pump 38. In this case, for example, as shown in the piping diagram of fig. 30, the pump 812 is connected to the 1 st port 630A of the three-way cock 630, the piping 40 is connected to the 2 nd port 630B, and the air hose 808 is connected to the 3 rd port 630C. The pipe 40 is provided with a valve 634, and the valve 634 is used to open the internal space 608 to the atmosphere (see fig. 14) and to allow the atmosphere to flow into the internal space 608.

When the cock 632 of the three-way cock 630 is manually operated to communicate the 1 st port 630A and the 2 nd port 630B, air in the internal space 608 (see fig. 14) can be sucked by the pump 812 switched to the suction side. Thereby, the hose body 606 is changed from the softened state to the cured state. The valve 634 is opened to open the internal space 608 to the atmosphere, so that the atmosphere can flow into the internal space 608. Thereby, the hose body 606 is changed from the cured state to the uncured state.

When the cock 632 of the three-way cock 630 is manually operated to communicate the 1 st port 630A with the 3 rd port 630C, air can be blown out from the air supply suction port 810 (see fig. 29) by the pump 812 switched to the pressurized side. Thereby, the bulge portion 802A expands. When the 1 st port 630A and the 3 rd port 630C are connected as described above, air can be sucked from the air supply suction port 810 (see fig. 29) by the pump 812 switched to the suction side. Thereby, the bulge portion 802A contracts.

In addition, instead of the manual switching operation using the three-way cock 630, the switching operation can be automated. In this case, for example, the piping 40 and the air hose 808 are connected to the pump 812 via separate solenoid valves, the valve 634 is constituted by the solenoid valves, and the opening and closing timings of the solenoid valves and the switching timings of the pressurization and suction of the pump 812 may be controlled by a controller. Thereby, the above-described switching operation can be automated.

Returning to fig. 28 and 29, a balloon 804 that is freely inflatable and deflatable is detachably attached to the distal end portion of the insertion portion 14. The balloon 804 is made of an elastic body such as rubber, and includes a central bulge portion 804A and attachment portions 804B and 804B at both ends thereof. The mounting portions 804B, 804B are each fixed to the outer surface of the curved portion 20.

As shown in fig. 29, an air hose 814 is inserted into the insertion portion 14 along the longitudinal axis G of the insertion portion 14, and a distal end of the air hose 814 is opened on the outer surface of the bending portion 20 located in the bulge portion 804A, thereby forming an air supply suction port 816. The base end of the air hose 814 is connected to a pump (not shown) disposed outside the insertion portion 14. Therefore, when air is supplied from the pump to the air hose 814, air is blown out from the air supply suction port 816, and the bulge portion 804A expands. On the other hand, when air is sucked from the pump, air is sucked from the air supply suction port 816 through the air hose 814, and the bulge portion 804A contracts. In addition, the pump 812 for the balloon 802 is preferably used as the pump for the balloon 804. In this case, the air hose 814 is connected to the pump 812 via a solenoid valve or the like, so that air can be supplied to the balloon 804 and air can be sucked from the balloon 804. If the pump 812 for the balloon 802 is used as the pump for the balloon 804 in this way, the initial cost and the running cost of the endoscope apparatus 800 can be reduced.

Next, an operation method of the endoscope apparatus 800 shown in fig. 28 will be described with reference to fig. 31 and 32. An example of the procedure when the endoscope apparatus 800 is applied as an apparatus for a small intestine mirror is illustrated in time series in XXXIA in fig. 31 to xxxih in fig. 32. In fig. 31 and 32, symbol Q denotes a stomach, symbol R denotes a pylorus, symbol S denotes a duodenum, symbol U denotes a small intestine, and symbol Z denotes a lesion.

First, the insertion portion 14 is inserted into the body in a state where the insertion portion 14 is inserted into the hose body 606 and the balloon 804 is contracted. That is, the distal end portion of the insertion portion 14 is inserted into the stomach Q from the mouth of the subject through the esophagus. In XXXIA of fig. 31, the distal end portion of the insertion portion 14 is inserted into the stomach Q.

Next, the hose body 606 is inserted into the body along the insertion portion 14 in a state where the balloon 802 is contracted and the hose body 606 is not cured. That is, the distal end portion of the tube main body 606 is inserted into the stomach Q from the mouth of the subject through the esophagus. In XXXIB of fig. 31, the distal end portions of the insertion portion 14 and the hose body 606 are inserted into the stomach Q.

Next, as shown in XXXIC of fig. 31, the insertion portion 14 is advanced relative to the hose body 606, and the distal end portion of the insertion portion 14 is inserted into the duodenum S via the pylorus R. In XXXIC of fig. 31, the insertion portion 14 is inserted along the curved shape of the duodenum S, and the distal end portion of the insertion portion 14 is inserted into the ascending portion of the duodenum S.

Next, as shown in XXXID of fig. 31, the balloon 804 is inflated to fix the insertion portion 14 in the body (insertion portion fixing step). In XXXID of fig. 31, the balloon 804 is closely adhered to the ascending portion of the duodenum S, and the insertion portion 14 is fixed to the duodenum S.

Next, as shown in XXXIE of fig. 31, in a state where the balloon 802 is contracted and the hose body 606 is uncured, the hose body 606 is relatively advanced with respect to the insertion portion 14 (hose body advancing step). In XXXIE of fig. 31, the hose body 606 is inserted along the curved shape of the duodenum S, and the distal end portion of the hose body 606 is inserted directly in front of the balloon 804 of the insertion portion 14.

Next, the hose body 606 is changed from the uncured state to the cured state. That is, the air in the internal space 608 (refer to fig. 14) of the hose body 606 is sucked by the pump 812 (refer to fig. 30), thereby curing the hose body 606. In XXXIE of fig. 31, a state in which the hose body 606 is fixed in a curved shape along the duodenum S is shown.

Next, as shown in XXXIF of fig. 31, in a state where the hose body 606 is in a cured state, the balloon 802 is inflated to fix the hose body 606 in the body (hose body fixing step). In XXXIF of fig. 31, the balloon 802 is closely adhered to the ascending portion of the duodenum S, and the hose body 606 is fixed to the duodenum S.

Next, as shown in XXXIG of FIG. 31, balloon 804 is deflated. In XXXIG of fig. 31, the balloon 804 is contracted, and the fixation of the insertion portion 14 to the duodenum S is released.

Next, as shown in XXXIH of fig. 31, the insertion portion 14 is advanced relative to the hose body 606 in a state where the balloon 804 is contracted (insertion portion advancing step). In XXXIH of fig. 31, the distal end portion of the insertion portion 14 is inserted into the deep portion of the small intestine U along the curved shape of the small intestine U. When the insertion portion 14 is advanced, the hose body 606 is cured into a curved shape along the duodenum S, so that the distal end portion of the insertion portion 14 can be stably advanced toward the deep portion of the small intestine U.

Next, as shown in xxxiii of fig. 32, the balloon 804 is inflated to fix the insertion portion 14 in the body (insertion portion fixing step). In XXXITA of fig. 32, the balloon 804 is closely adhered to the small intestine U, and the insertion part 14 is fixed to the small intestine U.

Next, as shown in xxxiii of fig. 32, the balloon 802 is deflated. In xxxiii of fig. 32, there is shown a state in which the balloon 802 is contracted and the fixation of the hose body 606 to the duodenum S is released.

Next, the hose body 606 is changed from the cured state to the uncured state. That is, the hose body 606 is softened by opening the atmosphere in the inner space 608 (see fig. 14) of the hose body 606 and allowing the atmosphere to flow into the inner space 608.

Next, as shown in xxxiii of fig. 32, the hose body 606 is relatively advanced with respect to the insertion portion 14 in a state where the balloon 802 is contracted and the hose body 606 is not cured (hose body advancing step). In xxxiii of fig. 32, the hose body 606 is inserted along the curved shape of the small intestine U, and the distal end portion of the hose body 606 is inserted directly in front of the balloon 804 of the insertion portion 14.

Next, as shown in xxxiii of fig. 32, the balloon 802 is inflated to fix the hose body 606 in the body. In xxxiii of fig. 32, the balloon 802 is closely adhered to the small intestine U, and the tube main body 606 is fixed to the small intestine U.

Next, as shown in xxxiii to xxxiff of fig. 32, the hose body 606 and the insertion portion 14 are integrally pulled out of the body. In xxxiff of fig. 32, the small intestine U is pulled toward the stomach Q side in a state where the balloons 802, 804 are in close contact with the small intestine U. By this operation, the small intestine U is contracted in the longitudinal direction, and therefore the lesion Z of the small intestine U can be brought close to the distal end portion of the insertion portion 14.

Next, the hose body 606 is changed from the uncured state to the cured state. That is, the air in the internal space 608 (refer to fig. 14) of the hose body 606 is sucked by the pump 812 (refer to fig. 30), thereby curing the hose body 606. In xxxiff of fig. 32, there is shown a state in which the hose main body 606 is cured into a shape along the curved shape of the contracted small intestine U.

Next, as shown in xxxig of fig. 32, the balloon 804 is contracted. In xxxig of fig. 32, the balloon 804 is contracted, and the fixation of the insertion portion 14 to the small intestine U is released.

Next, as shown in xxxih of fig. 32, the insertion portion 14 is advanced relative to the hose body 606 in a state where the balloon 804 is contracted (insertion portion advancing step). In xxxih of fig. 32, the distal end portion of the insertion portion 14 is inserted along the curved shape of the small intestine U and is inserted in the vicinity of the lesion Z. When the insertion portion 14 is advanced, the hose body 606 is cured into a shape along the curved shape of the small intestine U, and therefore the distal end portion of the insertion portion 14 can be stably advanced toward the lesion Z.

Next, when the distal end portion of the insertion portion 14 reaches the lesion Z, the balloon 804 is inflated to adhere to the small intestine U, thereby fixing the distal end portion of the insertion portion 14 to the small intestine U. Thereafter, a treatment tool (not shown) is inserted from the proximal end side of the insertion portion 14, and a treatment tool is guided from a treatment tool guide opening (not shown) on the distal end side of the insertion portion 14, and treatment of the lesion Z is started. In the treatment of the lesion Z by the treatment tool, the tube main body 606 is fixed to the small intestine U by the balloon 802, and the distal end portion of the insertion portion 14 is fixed to the small intestine U by the balloon 804, so that the distal end portion (distal end hard portion 18) of the insertion portion 14 can be positioned at an accurate treatment position. As a result, the lesion 506 can be accurately treated.

When the treatment is completed by the lesion Z of the treatment instrument, the balloon 804 is contracted with respect to the insertion portion 14 to release the fixation of the insertion portion 14 to the small intestine U. Regarding the hose body 606, the hose body 606 is changed from the cured state to the uncured state, and the balloon 802 is contracted to release the fixation of the hose body 606 with respect to the small intestine U. Thereafter, the insertion portion 14 and the hose body 606 are integrally pulled out of the body. The above is an example of the operation method of the endoscope apparatus 800.

In this way, according to the endoscope apparatus 800 having the structure in which the balloon 804 is provided in the insertion portion 14 and the balloon 802 is provided in the hose body 606, the distal end portion of the insertion portion 14 can be stably advanced toward the lesion Z existing in the deep portion of the small intestine U by selectively performing the step of expanding and contracting the balloon 804 (the 1 st expanding and contracting step), the step of expanding and contracting the balloon 802 (the 2 nd expanding and contracting step), the step of changing the hose body 606 between the uncured state and the cured state (the hardness-variable step), and the step of relatively advancing and retreating the insertion portion 14 and the hose body 606 (the advancing and retreating step). Further, the treatment by the lesion Z of the treatment instrument can be accurately performed.

The above embodiment is a system in which the balloon 804 is provided on the endoscope 12 side, but is not limited to this, and for example, the balloon 804 may be provided only on the guide tube 600 side instead of the endoscope 12 side. The operation method of the endoscope apparatus in this embodiment (i.e., the embodiment in which the balloon 802 is provided only on the guide tube 600 side) is basically the same as the operation method shown in fig. 31 and 32, but the insertion portion 14 can be fixed to the intestinal tract by performing an operation of bending the bending portion 20 to hang the distal end portion (distal end hard portion 18) on the intestinal tract or the like, instead of inflating the balloon 804 provided on the endoscope 12 side.

Several modifications of the hose body balloon attached to the hose body 606 will be described below.

Fig. 33 is a cross-sectional view showing a main portion of a balloon 820 according to modification 1. The balloon 820 is made of an elastic body such as rubber, and is composed of 2 bulging portions 820A, 820B and attachment portions 820C, 820C. The mounting portions 820C and 820C are fixed to the outer surface of the hose body 606, and the bulge portion 820A is mounted on the distal end side of the hose body 606 and the bulge portion 820B is mounted on the proximal end side of the hose body 606.

As shown in fig. 33, an air hose 822 is attached to the outer surface of the hose body 606 along the axis Ax, and the tip of the air hose 822 is opened in the bulge 820B to form an air supply suction port 824. The base end of the air hose 822 is connected to a pump (not shown) disposed outside the hose body 606. When air is supplied from the pump to the air hose 822, air is blown out from the air supply suction port 824, and the bulge portions 820A, 820B expand. On the other hand, when air is sucked from the pump, air is sucked from the air supply suction port 824 through the air hose 822, and the bulge portions 820A and 820B contract. Even the balloon 820 having 2 bulge portions 820A and 820B can be applied as a balloon for a hose body.

Fig. 34 is a cross-sectional view showing a main part of a balloon 830 according to modification 2. The balloon 830 is composed of a central bulge portion 830A and mounting portions 830B and 830B at both ends thereof, the mounting portion 830B at the tip end side being fixed to the inner surface of the hose body 606, and the mounting portion 830B at the base end side being fixed to the outer surface of the hose body 606. According to the balloon 830, when the bulge portion 830A is inflated, the bulge portion 830A can be inflated to both the radially outer side and the radially inner side of the hose body 606. As a result, the inflated bulge 830A can be in close contact with both the intestinal wall (not shown) and the insertion portion 14.

As shown in fig. 34, an air hose 832 is attached to the outer surface of the hose body 606 along the axis Ax, and the tip of the air hose 832 is opened in the bulge portion 830A to form an air supply suction port 834. The base end of the air hose 832 is connected to a pump (not shown) disposed outside the hose body 606. When air is supplied from the pump to the air hose 832, air is blown out from the air supply suction port 834, and the bulge portion 830A expands. At this time, since a part of the bulge portion 830A is in close contact with the insertion portion 14, it is possible to prevent the internal tissue (for example, the intestinal wall) from being pinched in the gap between the hose body 606 and the insertion portion 14. On the other hand, when air is sucked from the pump, air is sucked from the air supply suction port 834 through the air hose 832, and the bulge portion 830A is contracted. The balloon 830 having such a bulge 830A can be applied to a balloon for a hose body.

Fig. 35 is a cross-sectional view showing a main portion of a balloon 840 according to modification 3. Before explaining the balloon 840, the hose body 606 of this example has a cylinder 842 that accommodates the hose body 606 inside. A space 844 between the hose body 606 and the tubular body 842 is formed as a closed space, and the space 844 is configured as an air passage and is connected to a pump (not shown). The balloon 840 is attached to the front end portion of the cylinder 842, and an air supply suction port 846 is formed in the front end portion of the cylinder 842 located in the bulge portion 840A of the balloon 840. Thereby, the space 844 and the bulge 840A communicate via the air supply suction port 846. Further, the mounting portions 840B and 840B at both ends of the bulge portion 840A of the balloon 840 are fixed to the outer surface of the cylinder 842, and thereby mounted to the hose body 606.

According to the balloon 840 shown in fig. 35, when air is supplied from the pump to the space 844, air is blown out from the air supply suction port 846, and the bulge portion 840A is inflated. On the other hand, when air is sucked from the pump, air is sucked from the air supply suction port 846 through the space 844, and the bulge portion 840A contracts. Even the balloon 840 attached to the distal end portion of the tubular body 842 in this manner can be used as a balloon for a hose body.

Fig. 36 is a cross-sectional view showing a main portion of a balloon 850 according to modification 4. Before explaining the balloon 850, the hose body 606 of this example has a cylindrical body 852 that accommodates the hose body 606 inside. The space 854 between the hose body 606 and the tubular body 852 is a closed space, and the space 854 is configured as an air passage and is connected to a pump (not shown). The distal end portion of the tubular body 852 is made of an elastic body such as rubber, and the distal end portion thereof is formed as a bulge 850A of the balloon 85 o. The portion of the tubular body 852 other than the distal end portion functioning as the bulge 850A is made of a material (for example, hard plastic) that cannot expand and contract.

According to the balloon 850 shown in fig. 36, when air is supplied from the pump to the space 854, the distal end portion (i.e., the bulge 850A) of the tubular body 852 shown by the two-dot chain line in fig. 36 is inflated as shown by the solid line in fig. 36. On the other hand, when air is sucked from the pump, air is sucked through the space 854, and the bulge 850A contracts as shown by the two-dot chain line in fig. 36. Even the balloon 850 having the bulge 850A formed in the tubular body 852 can be applied as a balloon for a hose body.

Fig. 37 is a cross-sectional view showing a main portion of a balloon 860 according to modification 5. Before explaining the balloon 860, the hose body 606 of this example has a cylinder 862 that accommodates the hose body 606 inside. A thin portion functioning as a bulge 860A of the balloon 860 is formed at the distal end portion of the cylinder 862. A sealed space 866 is formed between the bulge 860A and the hose body 606.

As shown in fig. 37, a multi-lumen tube 864 is formed in barrel 860 along axis Ax. The distal end of the multi-lumen tube 864 opens into the sealed space 866 to form an air suction port 868. The proximal end of the multilumen tubing 864 is connected to a pump (not shown).

According to balloon 860 shown in fig. 37, when air is supplied from a pump to multi-lumen tube 864, air is discharged from air supply suction port 868 to sealed space 866, and bulge 860A is inflated as shown by the solid line in fig. 37. On the other hand, when air is sucked from the pump, air is sucked from the air supply suction port 868 through the multi-lumen tube 864, and the bulge portion 860A contracts as indicated by the two-dot chain line in fig. 37. Even the balloon 860 having the thin-walled bulge 860A formed in the cylinder 862 can be applied as a balloon for a hose body.

Fig. 38 is a front view of a balloon 870 according to modification 6. That is, fig. 38 is a front view of the balloon 870 when the distal end of the hose body 606 is viewed from the distal end side of the hose body 606.

As shown in fig. 38, the balloon 870 has 4 bulging portions 870A, 870B, 870C, 870D along the outer peripheral surface of the hose body 606 at the front end portion of the hose body 606. The balloon 870 is configured such that the inflation portions 870A, 870B, 870C, and 870D are capable of performing inflation and deflation operations independently.

According to the balloon 870 shown in fig. 38, the distal end portion of the hose body 606 can be fixed to the intestinal wall (not shown) by inflating the bulge portions 870A, 870B, 870C, 870D and bringing the bulge portions 870A, 870B, 870C, 870D into close contact with the intestinal wall (not shown). Further, by expanding at least 1 of the bulge portions 870A, 870B, 870C, 870D, the bulge portions are brought into close contact with the intestinal wall (not shown), and thereby the orientation of the distal end portion of the hose body 606 can be adjusted. Specifically, for example, if only the bulge 870A located at the upper side in fig. 38 is inflated to be in close contact with the intestinal wall, the distal end portion of the hose main body 606 can be inclined to the lower side in fig. 38. That is, by expanding at least 1 of the bulge portions 870A, 870B, 870C, 870D, the distal end portion of the hose body 606 can be inclined in 4 directions of up, down, left, and right in fig. 38. Even the balloon 870 having such the bulge parts 870A, 870B, 870C, 870D can be applied as a balloon for a hose body.

In fig. 38, the balloon 870 having 4 bulging portions 870A, 870B, 870C, 870D is illustrated as an example of the balloon capable of changing the orientation of the distal end portion of the hose body 606, but the present invention is not limited thereto. That is, the balloon having a structure having at least 1 or more of the bulge portions 870A, 870B, 870C, 870D may be applied.

Other embodiments

In the above-described embodiment, the balloon 802, 820, 830, 840, 850, 860, 870 is exemplified as the in-vivo sealing portion for sealing the distal end portion of the hose body 606 to the inside of the body, and other embodiments of the in-vivo sealing portion are described below with reference to fig. 39 and 40.

Fig. 39 is a perspective view of a main part of a hose body 606 to which other embodiments of the in-vivo sealing portion are applied. Fig. 40 is a main part sectional view of the hose body 606 shown in fig. 39.

As shown in fig. 39 and 40, the hose body 606 of the present example has a tubular body 880 accommodating the hose body 606 therein, and an internal sealing portion 882 of the present example is provided at a distal end portion of the tubular body 880, that is, a distal end portion of the hose body 606.

As shown in fig. 40, a thin portion 884 is formed at the front end portion of the tubular body 880. The thin portion 884 is formed along the circumferential direction of the tubular body 880, and a suction port 892 described later is formed in the thin portion 884. The thin portion 884 has a diameter smaller than the outer diameter of the tubular body 880 and larger than the inner diameter of the tubular body 880, and a sealed space 886 is formed between the thin portion 884 and the hose body 606.

As shown in fig. 40, a multi-lumen tube 888 is formed in a tube body 880 along the axis Ax. The distal end of the multi-lumen tube 888 is opened in the closed space 886 to form an air suction port 890. The proximal end of the multilumen tubing 888 is connected to a suction pump (not shown).

As shown in fig. 39, a plurality of the suction ports 892 are arranged along the circumferential direction of the thin portion 884. Therefore, the internal sealing portion 882 of this example is configured to have the suction port 892 disposed at the distal end portion of the hose body 606.

As shown in fig. 40, the internal sealing portion 882 includes a soft sponge member 894 covering the suction port 892. The sponge member 894 is formed in a tubular shape and is attached to the front end portion of the tubular body 880 recessed by forming the thin portion 884.

According to the internal sealing portion 882 configured as described above, when air is sucked from the suction pump, intestinal air is sucked from the plurality of suction ports 892 to the multilumen tubing 888 through the sealed space 866. By this suction operation, the distal end portion of the hose body 606 is sealed to the intestinal wall (not shown) via the tubular body 880 (sponge member 894). As a result, the distal end portion of the hose body 606 is fixed to the body. In this way, even the internal sealing portion 882 having the structure of the suction port 892 can seal the distal end portion of the hose body 606 to the inside of the body.

Further, since the body sealing portion 882 of the embodiment has the sponge member 894, the intestinal wall is adsorbed to the suction port 892 through the sponge member 894. This can protect the intestinal wall from the peripheral edge (edge) of the suction port 892, as compared with the case where the intestinal wall is directly sucked to the suction port 892. The sponge member 894 is not necessarily required, but is preferably provided in view of protecting the intestinal wall as described above. The sponge member 894 is an example of the porous anti-entanglement member of the present invention, but a porous body (for example, porous metal) made of a hard material (for example, metal) may be applied instead of the sponge member 894. However, when the hose body 606 is fixed to the body, the sponge member 904 acts as a buffer material for the intestinal wall, and thus can be applied more preferably than a hard porous body.

In the above embodiments, the example in which the endoscope having the insertion portion is applied is shown as the medical instrument guided by the medical instrument guide apparatus of the present invention, but the present invention is not limited thereto, and the present invention can be applied to, for example, a medical treatment instrument such as a manipulator.

While the example of the guide device for medical instrument and the endoscope device according to the present invention has been described above, the present invention may be modified or altered in several ways without departing from the spirit of the present invention.

Symbol description

1-endoscope apparatus, 10-guide tube, 10A-front end opening, 12-endoscope, 14-insertion portion, 16-hand-held operation portion, 18-front end hard portion, 20-bending portion, 22-soft portion, 24-illumination window, 26-observation window, 28-shape-variable body, 28A-shape-variable body, 28B-shape-variable body, 28C-shape-variable body, 28D-shape-variable body, 28E-shape-variable body, 30-outside hose, 32-inside hose, 34-hose body, 36-internal space, 38-pump, 40-piping, 42-joint ring member, 42A-joint ring member, 42B-joint ring member, 46-fixing ring member, 48-joint sheet, 49-fixing sheet, 50-sheet body, 52-connecting member, 54-high friction surface, 56-mesh tube, 60-guide tube, 70-guide tube, 80-guide tube, 90-guide tube, 100-guide tube, 104-spiral tube, 106-band member, 142-joint ring member, 142A-joint ring member, 142B-joint ring member, 242A-joint ring member, 242B-joint ring member, 342A-joint ring member, 342B-joint ring member, 442A-joint ring member, 442B-joint ring member, 500-large intestine, 502-sigmoid colon, 504-transverse colon, 506-lesion, 600-guide tube, 602-lateral hose, 604-inner hose, 606-hose body, 608-inner space, 610-hydrophilic, 612-shape changeable, 614-intermediate, 616-cap, 618-cap, 620-adhesive, 622-adhesive, 624-adhesive, 626-adhesive, 628-vent, 630-tee tap, 630A-1 st port, 630B-2 nd port, 630C-3 rd port, 632-tap, 634-valve, 640-spiral, 642-strip part, 644-high friction surface, 650-sheet, 652-sheet, 654-adhesive, 656-high friction surface, 700-spiral, 702-strip part, 710-spiral, 712-strip part, 720-spiral, 722-strip part, 730-coil, 732-band, 734-bend, 736-bend, 740-coil, 742-band, 744-protrusion, 746-protrusion, 750-guide tube, 800-endoscope apparatus, 802-balloon, 802A-bulge, 802B-mount, 804-balloon, 804A-bulge, 804B-mount, 806-wire, 808-air hose, 810-air supply suction port, 812-pump, 814-air hose, 816-air supply suction port, 820-balloon, 820A-bulge, 820B-bulge, 820C-mount, 822-air hose, 824-air supply suction port, 830-balloon, 830A-bulge, 830B-mounting portion, 832-air hose, 834-air supply suction port, 840-balloon, 840A-bulge, 840B-mounting portion, 842-cylinder, 844-space, 846-air supply suction port, 850-balloon, 850A-bulge, 852-cylinder, 854-space, 860-balloon, 860A-bulge, 862-cylinder, 864-multi-lumen tube, 866-closed space, 868-air supply suction port, 870-balloon, 870A-bulge, 870B-bulge, 870C-bulge, 870D-bulge, 880-cylinder, 882-internal seal, 884-thin wall, 886-seal, 888-multi-lumen tube, 890-air suction port, 892-suction port, 894-sponge member, a-1 st joint plate, ax-axis, a-1 st joint plate end region, B-2 nd joint plate end region, D-1 st joint plate set, E-2 nd joint plate set, T-thickness, f-bandwidth, G-longitudinal axis, Q-stomach, R-pylorus, S-duodenum, U-small intestine, Z-lesion.

Claims (38)

1. A guide device for a medical instrument, which guides the medical instrument into a body, wherein,

the guide device for medical instruments comprises:

a hose body having a flexible outer hose and a flexible inner hose disposed inside the outer hose; a kind of electronic device with high-pressure air-conditioning system

And a shape variable body provided between the outer hose and the inner hose and capable of being deformed in conformity with the shape of the hose body.

2. The guide device for medical instrument according to claim 1, wherein,

the guide device for medical instruments comprises an intermediate layer which is provided between the outer tube and the inner tube and can be in contact with the shape-variable member,

the guide device for a medical instrument includes a 1 st contact surface provided on the shape-variable body and a 2 nd contact surface provided on the intermediate layer and facing the 1 st contact surface, and at least a part of any one of the 1 st contact surface and the 2 nd contact surface includes a high friction surface.

3. The guide device for medical instrument according to claim 2, wherein,

the intermediate layer is disposed between the outer hose and the shape variable body.

4. The guide device for medical instruments according to claim 2 or 3, wherein,

The high friction surface is arranged on the 2 nd contact surface.

5. The guide device for a medical instrument according to any one of claims 2 to 4, wherein,

the high friction surface is arranged on the 1 st contact surface.

6. The guide device for a medical instrument according to any one of claims 2 to 5, wherein,

the intermediate layer has a higher modulus of elasticity than the outer hose and the inner hose.

7. The guide device for medical instrument according to claim 6, wherein,

the intermediate layer is formed by forming a sheet into a cylindrical shape.

8. The guide device for a medical instrument according to any one of claims 2 to 7, wherein,

the guide device for medical instruments has a fluid supply/discharge mechanism for supplying fluid to and discharging fluid from an inner space between the outer hose and the inner hose,

when the fluid in the internal space is discharged by the fluid supply/discharge mechanism, the shape variable body and the intermediate layer are frictionally engaged with each other via the high friction surface in the hose body, thereby maintaining the shape of the shape variable body.

9. The guide device for medical instrument according to claim 1, wherein,

The guide device for a medical instrument has a 1 st contact surface provided on the shape-variable body and a 2 nd contact surface provided on at least one of the outer hose and the inner hose and facing the 1 st contact surface, and at least a part of one of the 1 st contact surface and the 2 nd contact surface includes a high friction surface.

10. The guide device for medical instrument according to claim 9, wherein,

the guide device for medical instruments has a fluid supply/discharge mechanism for supplying fluid to and discharging fluid from an inner space between the outer hose and the inner hose,

when the fluid in the internal space is discharged by the fluid supply/discharge mechanism, the shape variable body and the one hose are frictionally engaged with each other via the high friction surface in the hose body, thereby maintaining the shape of the shape variable body.

11. The guide device for a medical instrument according to any one of claims 2 to 10, wherein,

the high friction surface is a resin layer formed by coating a resin on one of the contact surfaces.

12. The guide device for a medical instrument according to any one of claims 2 to 10, wherein,

The high friction surface is a roughened surface formed on the one of the contact surfaces.

13. The guide device for a medical instrument according to any one of claims 2 to 10, wherein,

the high friction surface is a resin layer formed by coating a resin on a roughened surface formed on one of the contact surfaces.

14. The guide device for a medical instrument according to any one of claims 1 to 13, wherein,

the shape variable body has a spiral pipe formed by winding a band-shaped member in a spiral shape on the outer peripheral side of the inner hose.

15. The guide device for a medical instrument according to any one of claims 1 to 14, wherein,

the shape variable body has a plurality of joint ring members arranged along an axial direction of the hose body,

the joint ring member has:

an annular fixing ring member provided so as to be capable of fixing a relative position with respect to the axial direction of the outer hose or the inner hose; a kind of electronic device with high-pressure air-conditioning system

And a plurality of joint pieces extending in a comb-tooth shape from the fixed ring member to at least one side in the axial direction, the plurality of joint pieces being arranged in a circumferential direction around the axial direction.

16. The guide device for medical instrument according to claim 15, wherein,

The joint ring member has a plurality of joint pieces extending from the fixing ring member to both sides in the axial direction, respectively.

17. The guide device for medical instruments according to claim 16, wherein,

when the joint ring members adjacent to each other in the axial direction among the plurality of joint ring members are 1 st joint ring member and 2 nd joint ring member, the joint piece of the 1 st joint ring member extending toward the 2 nd joint ring member side is 1 st joint piece, and the joint piece of the 2 nd joint ring member extending toward the 1 st joint ring member side is 2 nd joint piece,

the axial positions of the 1 st joint piece end region on the 2 nd joint ring member side of the 1 st joint piece and the 2 nd joint piece end region on the 1 st joint ring member side of the 2 nd joint piece are arranged at positions overlapping each other, and the circumferential positions are arranged at positions offset from each other.

18. The guide device for medical instrument according to claim 17, wherein,

the 1 st joint piece and the 2 nd joint piece are alternately arranged one by one along the circumferential direction.

19. The guide device for medical instrument according to claim 17, wherein,

The plurality of 1 st joint segment groups each composed of 2 or more 1 st joint segments and the plurality of 2 nd joint segment groups each composed of 2 or more 2 nd joint segments are alternately arranged along the circumferential direction.

20. The guide device for medical instruments according to claim 16, wherein,

when the joint ring members adjacent to each other in the axial direction among the plurality of joint ring members are 1 st joint ring member and 2 nd joint ring member, the joint piece of the 1 st joint ring member extending toward the 2 nd joint ring member side is 1 st joint piece, and the joint piece of the 2 nd joint ring member extending toward the 1 st joint ring member side is 2 nd joint piece,

the axial positions of the 1 st joint piece and the 2 nd joint piece are arranged at positions offset from each other, and the circumferential positions are arranged at positions offset from each other.

21. The guide device for medical instruments according to claim 16, wherein,

when the width of the joint ring member in the axial direction is set to W1 and the arrangement pitch of the joint ring member in the axial direction is set to P, the following expression P < W1 is satisfied.

22. The guide device for medical instruments according to claim 16, wherein,

When the width of the joint ring member in the axial direction is set to W1 and the arrangement pitch of the joint ring member in the axial direction is set to P, the following expression P > W1 is satisfied.

23. The guide device for a medical instrument according to any one of claims 16 to 22, wherein,

the plurality of joint pieces arranged in the circumferential direction are arranged at equal intervals in the circumferential direction.

24. The guide device for a medical instrument according to any one of claims 15 to 23, wherein,

the plurality of retainer ring members are equally spaced along the axial direction.

25. The guide device for a medical instrument according to any one of claims 15 to 24, wherein,

the joint sheet has: a rectangular sheet main body formed elongated in the axial direction; and a connecting member provided between the sheet main body and the fixing ring member and having a width smaller than that of the sheet main body.

26. The guide device for a medical instrument according to any one of claims 1 to 25, wherein,

at least one surface of the outer circumferential surface of the outer hose and the inner circumferential surface of the inner hose has a hydrophilic coating.

27. The guide device for a medical instrument according to any one of claims 1 to 26, wherein,

The medical instrument is an endoscope having an insertion portion inserted into a body.

28. The guide device for a medical instrument according to any one of claims 1 to 27, wherein,

the guide device for medical instruments includes a switching member capable of switching between opening of the atmosphere and inflow of the atmosphere to an internal space between the outer tube and the inner tube.

29. The guide device for a medical instrument according to any one of claims 1 to 28, wherein,

the hose body has an internal sealing portion provided at a distal end portion of the hose body.

30. The guide device for medical instrument according to claim 29, wherein,

the internal sealing portion is constituted by a balloon for a hose body which is disposed at a distal end portion of the hose body and which is capable of being inflated and deflated.

31. The guide device for medical instrument according to claim 29, wherein,

the internal sealing portion is configured to have a suction port arranged at a distal end portion of the hose body.

32. The guide device for medical instrument according to claim 31, wherein,

the internal sealing portion has a porous anti-rolling member covering the suction port.

33. An endoscope apparatus, wherein,

The endoscope device is provided with:

the medical device; a kind of electronic device with high-pressure air-conditioning system

The guide device for medical instrument of any one of claim 1 to 32,

the medical instrument is an endoscope having an insertion portion inserted into a body.

34. The endoscopic device of claim 33, wherein,

the endoscope has a switching unit capable of switching between atmosphere opening and atmosphere inflow to an internal space between the outer hose and the inner hose.

35. The endoscopic device of claim 33 or 34, wherein,

the insertion portion is capable of being inserted into the hose body,

in a state where the insertion portion is inserted into the hose body, a gap for preventing the pinching of the tissue in the body is formed between the hose body and the insertion portion.

36. The endoscopic device of claim 35, wherein,

the gap is below 4 mm.

37. The endoscopic device of any one of claims 33 to 36, wherein,

the insertion portion has an effective length of 300mm or more longer than the total length of the hose body.

38. The endoscopic device of any one of claims 33 to 37, wherein,

The insertion portion has an inflatable insertion portion balloon provided at a distal end portion of the insertion portion.