JP2000126195A - Medical grasping device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To accurately guide the tip of an insertion part of an endoscope into an opening of a uterus by providing a guide means on the side of one grip part of a pair of tissue grip parts opposite to the opposed side of the other grip part to guide an inserting part of the endoscope to the front side of the tissue grip parts in a strong jig provided with the tissue grip parts at the tip thereof. SOLUTION: In this medical grasping device 1, an upper grip bar 2 and a lower grip bar 3 are rotatably linked through a pin 4 and upper and lower grip parts 8 and 9 having inclinations α and β are successively arranged at the tips of the grip bars 2 and 3 through a part 7 bent in a low. Hook-shaped pawls 11a and 11b are extended at the tips of the grip parts 8 and 10 in the direction of facing each other. In the grasping device 1 thus arranged, a cylindrical endoscope insertion guide 12 with the inner diameter so set to be larger than the outer diameter of the inserting part 18 of an endoscope 17 is fixed on the rear side of the pawl 11a at the upper grip part 8. The inserting part 18 of the endoscope 17 is inserted into an insertion guide 12 to accurately guide the tip of the inserting part 18 to an opening 15 of a uterus.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical holding device for holding a living tissue.

[0002]

2. Description of the Related Art Intrauterine examinations and transvaginal use of endoscopes
When performing a procedure or the like, an endoscope is inserted into the uterus via the vagina and the cervix. At this time, the examiner guides the distal end of the insertion portion of the endoscope to the external cervix while visually observing, but the external cervix is located deep in the vagina and about 70 ° from the axis of the vagina. Since the opening is provided in the inclined direction, it is difficult to visually confirm the opening, and it may be difficult to guide the tip of the insertion portion of the endoscope into the external cervix. The vagina and the cervix and the cervix and the uterus each have an inclination of about 70 degrees, and the body cavity from the vagina to the uterus has a considerably bent structure. Therefore, it may be difficult to insert the endoscope smoothly. Therefore, in such a case, it is common to insert the endoscope into the uterus using a single hook forceps.

[0003] A single hook forceps has a sharp hook-like shape with a sharp tip, and is a holding tool used when performing endoscopic examination and treatment in the uterus. When the lower part of the cervico-vaginae is pinched by the hook-shaped tip of this pincer, pulling the pincer toward the hand makes it easier to observe the external cervix and eases the degree of flexion from the vagina to the uterus. You. Thereby, the insertability of the endoscope is improved.

[0004]

As described above, when the cervical vagina is towed while grasping the cervico-vaginal region with a holding tool (single hook forceps), this towing operation and the endoscope insertion operation are performed by one person. If the operation is performed only by the operator, it is necessary to hold the holding device with one hand and hold the operation section of the endoscope with the other hand. For this reason, the insertion portion of the endoscope cannot be supported by hand. Especially, in the case of a flexible endoscope, the insertion part is soft, so if the insertion part is not supported, the tip of the insertion part may be blurred, and it may be difficult to accurately guide the tip of the insertion part to the external cervix. .

[0005] Further, when the assistant holds the holding device or when the uterus is towed by using the own weight of the holding device while fixing the holding state of the cervix-vaginal region by the ratchet or the like, the operator is required Can be inserted by supporting the insertion portion of the endoscope by hand. However, because the finger can only enter near the vaginal opening,
It is necessary to support the insertion portion at a position somewhat away from the distal end of the insertion portion. For this reason, the tip of the insertion portion may be blurred, and it may be difficult to accurately guide the tip of the insertion portion to the external uterine ostium.

The present invention has been made in view of the above circumstances, and a purpose thereof is to provide a medical pinch that can easily and accurately guide the distal end of an insertion portion of an endoscope to an external cervix. To provide tools.

[0007]

In order to solve the above-mentioned problems, the present invention provides a medical holding device for holding a tissue by a pair of tissue holding portions provided at the distal end. A guide means for guiding the insertion portion of the endoscope to the front side of the tissue grasping portion in a predetermined direction is provided on the side opposite to the side facing the other tissue grasping portion.

[0008]

Embodiments of the present invention will be described below with reference to the drawings. 1 and 2 show a first embodiment of the present invention. As shown in FIG. 1, the medical holding device 1 of the present embodiment is configured by rotatably connecting an upper gripping bar 2 and a lower gripping bar 3 via a pin 4. On each base end side of the lower gripping rod 3,
A finger hole 5 for opening and closing the upper grip bar 2 and the lower grip bar 3 and a ratchet 6 for arbitrarily locking the relative position between the upper grip bar 2 and the lower grip bar 3 are provided. Is provided.

An upper grip having an inclination α (0 <α <90 °) with respect to the longitudinal axis of the upper grip rod 2 is provided at the tip of the upper grip rod 2 via an upper bent portion 7 bent in a U-shape. The part 8 is extended forward. The tip of the lower gripping bar 3 has an inclination β (0 <β <90 °) with the longitudinal axis of the lower gripping bar 3 via a lower bent portion 9 bent in a V shape. The lower grip 10 extends forward. Further, hooks 11a and 11b each having a hook-like shape are extended from each end of the upper grip 8 and the lower grip 10 in the directions facing each other.

As shown in FIG. 2, the length of the upper grip 8 is set to L. In addition, a cylindrical endoscope insertion guide 1 is provided on the upper grip 8 on the back side of the claw 11a.
2 is fixed. The inner diameter of the endoscope insertion guide 12 is set to be larger than the outer diameter of the insertion portion 18 of the endoscope 17, and the endoscope insertion guide 12 is fixed in parallel with the longitudinal axis of the upper grip 8. The distal opening 13 of the insertion guide 12 is located at a distance M from the distal end of the upper grip 8, and the proximal opening 14 is located at an arbitrary position on the upper grip 8. in this case,
M is desirably within 10 mm.

Next, a description will be given of a case where the insertion portion 18 of the endoscope 17 is guided to the external cervix using the medical holding device 1 having the above configuration. First, while the finger hole 5 is opened, the tip of the upper grip 8 is lightly inserted into the external cervix 15, and the tip of the lower grip 10 is placed below the cervico-vaginae 16. The hole 5 is slowly closed, and the lower part of the cervico-vaginal part 16 is completely grasped by the pair of claws 11a and 11b. Next, in a state where the relative position between the upper gripping bar 2 and the lower gripping bar 3 is fixed by the ratchet 6, the clamping device 1 is pulled toward the hand side to reduce the degree of bending from the vagina to the uterus. The insertion section 18 of the endoscope 17 is inserted into the insertion guide 12 from the proximal opening 14 of the insertion guide 12. Since the distal opening 13 of the insertion guide 12 is located near the entrance of the external cervix 15, when the endoscope 17 is further advanced, the insertion section 18 is naturally guided to the external cervix 15. Is done.

As described above, the medical holding device 1 of the present embodiment has a pair of claws 11a and 11b for holding tissue.
And the insertion guide 12, the claws 11a, 1
If the lower part of the cervico-vaginal part 16 is completely grasped and pulled by 1b to reduce the degree of bending from the vagina to the uterus in 1b, the insertion part 18 of the endoscope 17 is inserted into the insertion guide 12. Just by inserting the insertion part 18 easily and accurately
5 can be led.

FIG. 3 shows a second embodiment of the present invention. In the medical holding device according to the present embodiment, the insertion guide 12 has a bent portion 19 bent at an angle of inclination γ near the upper bent portion 7, and the proximal opening 14 of the insertion guide 12 is located on the upper side. It is provided closer to the hand than the bent portion 7.
The direction of the inclination γ is set to coincide with the direction of the inclination α, and satisfies the relationship α ≦ γ <90 °. The other configuration is the same as that of the first embodiment.

Therefore, according to such a configuration, since the proximal end opening 14 is located closer to the hand than the first embodiment, the proximal end opening 14 can be easily checked, and the insertion portion 18 can be connected to the proximal end. It is easy to guide to the side opening 14.

FIG. 4 shows a third embodiment of the present invention. In the medical holding device according to the present embodiment, the insertion guide 12 is formed of a soft tube. Insertion guide 12
Is fixed to the upper gripping portion 8 only near its tip,
The proximal end opening 14 of the insertion guide 12 is provided closer to the hand than the upper bent portion 7. The other configuration is the same as that of the first embodiment.

Therefore, according to such a configuration, since the insertion guide 12 is made of a flexible tube, the insertion portion of the flexible endoscope is hardly damaged. In the third embodiment, the insertion guide 12 may be formed by a semi-rigid tube. In this case, even if there is a difference between patients in the degree of bending from the vagina to the cervix and the depth of the vagina, the proximal opening 14 of the insertion guide 12 is moved to a position preferred by the operator for each patient. Since the insertion portion 18 can be fixed, the insertion portion 18 can be easily guided to the base end side opening portion 14.

FIG. 5 shows a fourth embodiment of the present invention. In the medical holding device according to the present embodiment, the upper grip portion 8, the upper bent portion 7, and the upper grip bar 2 are integrally formed of a cylindrical member having an inner diameter larger than the outer diameter of the insertion portion 18 of the endoscope 17. Is formed. The upper grip portion 8 has a first notch portion 20 formed by notching the circumferential surface portion on the back side of the claw 11a for about half the circumference up to a position away from the tip by a distance M.
Is provided. Further, from the position away from the distal end of the upper gripping portion 8 by a distance N to the base end side of the upper gripping rod 2, the first
Similarly to the cutout portion 20, a second cutout portion 21 is formed by cutting out the cylindrical member over about half a circumference. In this case, L, M, and N are set to satisfy the relationship of M <N ≦ L. Therefore, the insertion guide 12 is
It is formed by the cylindrical member left between the notch 20 and the second notch 21. The other configuration is the same as that of the first embodiment.

The endoscope 1 using the holding device having such a configuration is described.
In order to guide the insertion portion 18 to the external cervix, the insertion portion 18 is advanced forward along the inner peripheral surface of the second cutout portion 21 and inserted into the insertion guide 12. . Since the distal opening 13 of the insertion guide 12 is located near the entrance of the external cervix 15, when the endoscope 17 is further advanced, the insertion section 18 is naturally guided to the external cervix 15. .

As described above, according to the medical holding device of the present embodiment, the insertion portion 18 can be advanced forward while sliding on the inner peripheral surface of the second cutout portion 21. The portion 18 can be easily guided to the proximal opening 14 of the insertion guide 12. In addition, since the insertion guide 12 is formed integrally with the upper grip 8, the number of components is reduced, and the cost can be reduced.

FIG. 6 shows a fifth embodiment of the present invention. This embodiment is a modification of the fourth embodiment, and the proximal opening 14 is formed closer to the hand than the upper bent portion 7. In such a configuration, similar to the fourth embodiment,
Since the insertion portion 18 can be advanced forward while sliding on the inner peripheral surface of the second notch portion 21, and the proximal opening portion 14 is located closer to the hand than the fourth embodiment, It is easy for the surgeon to check the proximal opening 14 and guide the insertion portion 18 to the proximal opening 14 of the insertion guide 12.

FIG. 7 shows a sixth embodiment of the present invention. In the medical holding device of the present embodiment, the upper grip 8
The upper bent portion 7 and the upper gripping bar 2 are integrally formed of a cylindrical member having an inner diameter larger than the outer diameter of the insertion portion 18 of the endoscope 17. In addition, a cutout portion 22 is provided from the distal end of the upper gripping portion 8 to the base end side of the upper gripping bar 2, which is formed by cutting out the peripheral surface portion on the back side of the claw 11 a over about half a circumference.

In such a configuration, when the insertion portion 18 is advanced forward along the inner peripheral surface of the notch portion 22, the tip of the notch portion 22 is located at the external cervix 15. The part 18 is naturally guided into the external cervix 15.
In the configuration of the present embodiment, the insertion guide 12 is
In addition, since the insertion guide 12 is easily formed, the cost can be reduced.

FIGS. 8 to 11 show an endoscope 17 used with the medical holding device of the present invention. As shown in FIG. 8, the endoscope 17 includes an operation unit 23 and an insertion unit 18.
The operation unit 23 is provided with an angle operation knob 24, an eyepiece unit 25, and the like. The insertion section 18 includes a flexible tube 26
, A curved portion 27 and a tip member 28. The bending portion 27 is interposed between the flexible tube 26 on the proximal end side and the distal end member 28 at the foremost end, and a pair of upper and lower operation wires 32 (see FIG. 9)).

As shown in FIG. 9, the bending portion 27 is constituted by a bending tube 30 in which a plurality of node rings 29 are rotatably connected in a line via a shaft member 93. The outer surface of the curved tube 30 is covered with an outer tube 31. The node ring 29 is formed in a thin cylindrical shape, and a pair of tongue pieces 92 are provided on both end edges of the node ring 29 at symmetrical positions on the diameter so as to face each other in parallel. Each tongue piece 92 protrudes from the edge of the main body portion of the node ring 29 along the longitudinal axis direction of the insertion portion 18, and is provided integrally with the node ring 29.

As shown in FIG. 10, the outer tube 3
1 has a two-layer structure of an outer tube 33 and an inner tube 34, and at least the outer tube 33 is made of a biocompatible resin material. Since the outer envelope tube 31 has a two-layer structure, pinholes hardly occur in manufacturing. The inner tube 34
Since does not touch the living body, any coloring may be performed. Therefore, if transparent resin is used for the outer layer tube 33, the outer tube 31 of various colors that is safe for a living body can be manufactured.

As shown in FIG. 11, the operation wire 32
Is formed by twisting a plurality of strands 36 coated with a lubricant 35 in advance. Even if the bending portion 27 is bent, the frictional resistance between the wires 36 is small, so that the operation wire 32 can be bent neatly, and the wires are hardly broken.

FIG. 12 shows a cross section of the connecting portion of the node ring 29 in the bending tube 30. Each tongue piece 92 (92a, 92
A hole 94 is provided in b). The tongue piece 92a on the front end side of the node ring 29 and the tongue piece 92b on the rear end side of the node ring 29 adjacent in front of the node ring 29 are arranged at positions where the centers of the respective holes 14 overlap. The shaft member 93 is inserted from the lumen side of the node ring 29, and the end of the shaft member 93 protruding to the outer peripheral side is swaged, and the tongue piece 92a on the front end side of the node ring 29 and the adjacent node ring 29 The adjacent node rings 29 are rotatably connected to each other by rotatably joining the rear end side tongue piece 92b.

[0028] At this time, assuming that the tongue piece 92a is positioned on the axial center side of the bending tube 30 than the tongue 92b, the distance r _a from the axial center to the outer peripheral surface of the tongue piece 92a is likewise tongue from the axial center to be larger than the distance r _b to the inner peripheral surface of 92b. Further, the length L of the portion is the axis of the shaft member 93 is caulked to always be larger than the sum of the thickness d _b of the thickness d _a and the tongue 92b of the tongue 92a. Similarly, a gap is provided between the tongue piece 92a and the tongue piece 92b as shown in FIG. 12 by caulking the other tongue pieces 92 at symmetrical positions on the diameter.

Conventionally, when the tongue pieces of the node ring are overlapped and rotatably connected to each other, the rivets are caulked until one tongue piece and the other tongue piece are completely adhered. for that reason,
There has been a problem that the frictional resistance is increased on the contact surface between the tongue pieces, the force of the bending operation is increased, and the operation wire is burdened and the operation wire is easily cut. However, when a gap is provided between the tongue pieces 92, 92 as in this configuration, no frictional resistance is generated when the node ring 29 is rotated.
Therefore, the bending operation can be performed with a light force,
The load on the operation wire can be reduced to prevent the wire from being cut.

FIG. 13 shows a connecting portion 97 between the flexible tube 26 and the bending portion 27. At a connection portion 97 between the flexible tube 26 and the bending portion 27, a connection pipe 119 is bonded and fixed on an inner peripheral surface of the flexible tube 26. The connection pipe 119 is also fixed to the bending tube 30 and the outer tube 31 on the other hand. Further, a fixing pipe 120 is bonded and fixed to the outer peripheral surface of the flexible tube 26 in the connection portion 97. At this time, the outer diameter of a portion of the connection pipe 119 located on the distal side from the distal end surface of the flexible tube 26 is formed smaller than the outer diameter of the distal end surface of the flexible tube 26. The connection between the outer tube 31 of the bending portion 27 and the connection pipe 119 is made by the flexible tube 2.
6 and the connection pipe 119 are bonded and fixed, and then the outer tube 31 is put on the outer peripheral surface of the connection pipe 119, and the operation section side end surface of the outer tube 31 is made to coincide with the distal end side end surface of the flexible tube 26, and then bonded and fixed. I do. With this configuration, since the distal end surface of the flexible tube 26 is exposed until the outer tube 31 is fixed to the connection pipe 119, the watertightness of the bonding surface between the connection pipe 119 and the flexible tube 26 is reduced. Confirmation becomes easy.

FIG. 14 shows a configuration for mounting the operation wire 32 in the operation section 23. The operation wire 32 is
Inside the flexible tube 26, it is inserted into a closely wound coil 122 (see also FIG. 13) fixed to the flexible tube 26. A coil cover 123 is adhered and fixed to the operation section side end of the close-wound coil 122, and the operation section side end face of the close-wound coil 122 protrudes from the operation section side end face of the coil cover 123. The stopper 129 is provided on the frame 129 of the operation unit 23.
21 is screwed and fixed. In the stopper 121,
A hole 124 having an abutting portion 125 is formed in the close-wound coil 122 in the axial direction.

The coil cover 123 is connected to the stopper 12
One hole 124 is fitted. At this time, the coil cover 1
Reference numeral 23 abuts against the abutting portion 125, and the tip of the close-wound coil 122 protrudes more toward the operation unit than the abutting portion 125. Thus, the densely wound coil 122 is closer than the end face of the stopper 121.
When the operation wire 32 is pulled obliquely with respect to the axial direction, the operation wire 32 does not suddenly bend at the end face of the stopper 121 and the tightly wound coil 122
Bends gently due to the protruding part of. Therefore, the operation wire 32 does not rub on the end face of the close-wound coil 122.

According to the technical contents described above, the following various configurations can be obtained. 1. What is claimed is: 1. A medical holding device having a pair of tissue grasping portions at a distal end, wherein an insertion guide of an endoscope is provided on one of the tissue grasping portions.

2. 2. The medical holding device according to claim 1, wherein the insertion guide is provided on a back side of surfaces facing each other of the pair of tissue grippers. 3. 3. The medical holding device according to claim 2, wherein the insertion guide is formed of a cylindrical member having an inner diameter larger than an outer diameter of an insertion portion of the endoscope.

4. 4. The medical holding device according to claim 3, wherein the cylindrical member is rigid. 5. The third cylindrical member is flexible;
6. The medical holding device according to item 5.

6. The medical holding device according to claim 3, wherein the cylindrical member is semi-rigid. 7. 2. The medical holding device according to claim 1, wherein the tissue grasping portion and the insertion guide are integrally formed of a cylindrical member having an inner diameter larger than an outer diameter of the insertion portion of the endoscope.

8. The medical holding device according to claim 1, wherein the tissue gripping portion and the insertion guide are integrally formed by a semi-cylindrical member having an inner diameter larger than an outer diameter of the insertion portion of the endoscope.

9. A plurality of node rings having a rotation axis perpendicular to the bending direction of the endoscope insertion section are arranged in the longitudinal direction of the endoscope insertion section, and adjacent node rings are provided with a tongue provided on the node ring. In a bending device for an endoscope rotatably connected to each other by passing a shaft member through a hole formed in a piece, a gap is provided between tongue pieces joined by the shaft member. Endoscope bending device.

[0039]

As described above, according to the medical holding device of the present invention, the distal end of the insertion portion of the endoscope can be easily and accurately guided to the external cervix.

[Brief description of the drawings]

FIG. 1 is a view showing a use mode of a medical holding device according to a first embodiment of the present invention.

FIG. 2 is a perspective view showing a main part of the medical holding device according to the first embodiment of the present invention.

FIG. 3 is a perspective view showing a main part of a medical holding device according to a second embodiment of the present invention.

FIG. 4 is a perspective view showing a main part of a medical holding device according to a third embodiment of the present invention.

FIG. 5 is a perspective view showing a main part of a medical holding device according to a fourth embodiment of the present invention.

FIG. 6 is a perspective view showing a main part of a medical holding device according to a fifth embodiment of the present invention.

FIG. 7 is a perspective view showing a main part of a medical holding device according to a sixth embodiment of the present invention.

FIG. 8 is a side view of an endoscope used with the medical holding device of the present invention.

FIG. 9 is a sectional view of a bending portion of the endoscope of FIG. 8;

FIG. 10 is a sectional view of an outer skin of a bending portion of the endoscope in FIG. 8;

FIG. 11 is a cross-sectional view of an operation wire for bending a bending portion of the endoscope of FIG. 8;

FIG. 12 is a cross-sectional view showing a connection form between articulation rings constituting a bending portion of the endoscope in FIG. 8;

FIG. 13 is a sectional view of a connecting portion between the bending portion and the flexible tube of the endoscope in FIG. 8;

FIG. 14 is a sectional view showing a structure for attaching an operation wire in the operation section of the endoscope in FIG. 8;

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Medical holding tool 8, 10 ... Grip part 12 ... Insertion guide (guide means)

 ──────────────────────────────────────────────────続 き Continued on the front page F term (reference) 2H040 AA00 DA03 DA12 DA14 DA15 DA16 DA19 DA21 DA54 DA56 4C060 GG29 HH20 4C061 AA16 BB01 CC00 DD03 GG15 GG22 HH21 JJ06

Claims (2)

[Claims] 1. A medical holding device for holding a tissue by a pair of tissue holding portions provided at a distal end thereof, wherein one tissue holding portion has an endoscope on an opposite side to a side facing the other tissue holding portion. A medical holding device comprising a guide means for guiding an insertion portion of a mirror in a predetermined direction in front of a tissue grasping portion. 2. The apparatus according to claim 1, wherein the guide means comprises a cylindrical member fixed to a tissue gripper, and an inner diameter of the cylindrical member is larger than an outer diameter of an insertion portion of the endoscope. Medical jaws.