JP2000325303A - 内視鏡治療装置 - Google Patents

内視鏡治療装置

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Publication number
JP2000325303A
JP2000325303A JP11135822A JP13582299A JP2000325303A JP 2000325303 A JP2000325303 A JP 2000325303A JP 11135822 A JP11135822 A JP 11135822A JP 13582299 A JP13582299 A JP 13582299A JP 2000325303 A JP2000325303 A JP 2000325303A
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Japan
Prior art keywords
treatment
endoscope
tool
guiding
tools
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JP4503725B2 (ja
Inventor
Yorio Matsui
頼夫 松井
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Olympus Corp
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Olympus Optical Co Ltd
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Abstract

(57)【要約】 【課題】内視鏡の視界を妨げることなく、病変部位に対
してその治療に適切な方向から処置具を容易に遠隔操作
することができる内視鏡治療装置を提供する。 【解決手段】内視鏡治療装置１は、内視鏡２と、処置具
としての２つの鉗子３と、２つの鉗子３が挿通されると
ともに、互いに対称な向きに湾曲する第１、第２の湾曲
部２８ａ，２８ｂがそれぞれ１つずつ設けられた２本の
処置具誘導挿入具４と、内視鏡２に対して２本の挿入具
４を互いに対称な位置に配置して保持する治療装置誘導
チューブ体５などから構成される。装置１を患者の体腔
内に挿入し、病変部位を内視鏡２で観察しつつ、遠隔操
作により第１、第２湾曲部２８ａ，２８ｂを湾曲させ
て、内視鏡遠位端面１３から離れた、内視鏡２の両側の
対称な位置において、２つの鉗子３で病変部位を把持す
る。これにより、内視鏡２の視界を妨げずに、内視鏡２
に内蔵された電気メス１６で病変部位を切除できる。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は、例えば、内視鏡と
処置具とをともに患者の体腔内に挿入し、内視鏡により
体腔内の病変部位の観察しつつ、体腔外から処置具を遠
隔操作することにより病変部位の治療を行なう内視鏡治
療装置に関する。
【０００２】
【従来の技術】内視鏡と処置具とを組み合わせて体腔内
の治療を行なう内視鏡治療装置として、例えば、特開昭
５４−１３６７８０号公報の発明が提案されている。挿
入案内用主管の内部に形成された複数のチャンネルの内
部に、内視鏡および処置具のそれぞれを独立に挿通させ
て、挿入案内用主管ごと体腔内に導入する。挿入案内用
主管ごと内視鏡および処置具を体腔内の病変部位の近辺
まで誘導した後、挿入案内用主管のチャンネル内から内
視鏡および処置具のそれぞれを独立に突出させる。病変
部位を内視鏡で観察しつつ、処置具を操作して病変部位
の治療を行なう。
【０００３】
【発明が解決しようとする課題】内視鏡と処置具との相
対的な位置関係は、内視鏡および処置具のそれぞれが独
立に挿通されるチャンネルの、挿入案内用主管の内部に
おける配置により決定される。ひいては、病変部位を治
療する際の内視鏡の可視範囲と処置具の操作範囲との相
対的な位置関係も略決定される。挿入案内用主管の径の
大きさは、人間の口腔および咽喉を通過できる程度であ
る。
【０００４】そのような大きさの径の挿入案内用主管の
内部にチャンネルを複数形成した場合、それぞれのチャ
ンネル同士が互いに接近した配置となり、内視鏡および
処置具も互いに接近した配置となる。ひいては、体腔内
において挿入案内用主管の遠位端から突出する、内視鏡
および処置具のそれぞれ可動範囲の大部分が干渉し合
い、互いに相手の可動範囲を制限し合う。このため、体
腔内、例えば、胃の中にできた病変部位の位置によって
は、内視鏡で病変部位を観察しつつ、処置具を操作して
病変部位を切除するなどの適切な治療を施し難くなるお
それがある。
【０００５】本発明が解決しようとする課題は、体腔内
において、体腔の場所および病変部位の位置に拘わらず
に、内視鏡による病変部位の観察を行ない易く、かつ、
内視鏡による病変部位の観察下において、その視界を妨
げるおそれがないとともに、病変部位に対してその治療
に適切な方向から処置具を容易に操作することができる
内視鏡治療装置を得ることにある。
【０００６】
【課題を解決するための手段】前記課題を解決するため
に、請求項１の発明に係る内視鏡治療装置は、可撓性を
有する挿入部を備えた内視鏡と、この内視鏡による観察
下において使用する複数の処置具と、これら複数の処置
具のうち少なくとも２つを独立に挿通して体腔内に誘導
する処置具用管路を備えるとともに、可撓性を有する挿
入部を備えた２本の処置具誘導挿入具と、前記内視鏡お
よび前記２本の処置具誘導挿入具のそれぞれの挿入部を
体腔内に誘導するとともに、前記２本の処置具誘導挿入
具のそれぞれの挿入部を前記内視鏡の挿入部に対して互
いに所定の対称位置に配置する治療装置用管路を備える
治療装置誘導チューブ体とを具備し、前記２本の処置具
誘導挿入具のそれぞれの挿入部の遠位端部には、前記２
本の処置具誘導挿入具のそれぞれの近位端部から遠隔操
作することにより、前記内視鏡の挿入部に対して互いに
所定の対称な向きに湾曲させられる湾曲部が設けられて
いることを特徴とするものである。
【０００７】この発明の内視鏡治療装置においては、２
本の処置具誘導挿入具は内視鏡に対して互いに対称な位
置に配置される。それとともに、２本の処置具誘導挿入
具のそれぞれの近位端部から遠隔操作することにより、
２本の処置具誘導挿入具のそれぞれの遠位端部に設けら
れている湾曲部のそれぞれを、内視鏡の挿入部に対し
て、互いに所定の対称な向きに湾曲させる。複数の処置
具は、このような構成の２本の処置具誘導挿入具のそれ
ぞれの内部に設けられている処置具用管路にそれぞれ独
立に挿通されて、処置具誘導挿入具の挿入部の遠位端か
ら体腔内に露出される。これにより、２つの処置具は、
ともに内視鏡の視界を殆ど妨げることなく、かつ、それ
ぞれ互いに相手の可動範囲を制限することなく、広い範
囲を、異なる向きに動くことができる。
【０００８】また、前記請求項１の発明を実施するにあ
たり、この発明に従属する請求項２の発明のように、前
記２本の処置具誘導挿入具のそれぞれの挿入部の遠位端
部に、その長手方向に沿って、互いに対向する位置に前
記湾曲部をそれぞれ複数ずつ設置するとともに、互いに
対向する位置に設置された前記複数の湾曲部ごとに、そ
れぞれ異なる所定の対称な向きに、前記内視鏡の挿入部
に対して互いに湾曲する構成とするとよい。
【０００９】この発明の内視鏡治療装置においては、前
記請求項１に記載の発明の作用に加えて、２本の処置具
誘導挿入具のそれぞれに、その長手方向に沿って、対称
な位置に湾曲部を複数ずつ設けるとともに、それぞれの
湾曲部が互いに異なる所定の対称な向きに湾曲するよう
にした。これにより、２つの処置具は、ともに内視鏡の
視界を殆ど妨げることなく、かつ、それぞれ互いに相手
の可動範囲を制限することなく、より広い範囲を、より
多様に異なる向きに動くことができる。
【００１０】また、前記請求項２の発明を実施するにあ
たり、この発明に従属する請求項３の発明のように、前
記複数の湾曲部のうち、それぞれの最近位側に設置され
た前記湾曲部は、これらの最近位側に設置された湾曲部
より遠位側の前記２本の処置具誘導挿入具のそれぞれの
挿入部の長手方向が、ともに前記内視鏡の挿入部の長手
方向に対して乖離および接近する方向に沿って、互いに
対称な向きに湾曲する構成とするとよい。
【００１１】この発明の内視鏡治療装置においては、前
記請求項２に記載の発明の作用に加えて、複数の湾曲部
のうち、それぞれの最近位側の湾曲部の湾曲する向き
を、２本の処置具誘導挿入具のそれぞれの挿入部がとも
に前記内視鏡の挿入部から離れるような、互いに対称な
向きとした。これにより、２つの処置具は、ともに内視
鏡の視界を殆ど妨げることなく、かつ、それぞれ互いに
相手の可動範囲を制限することなく、さらに広い範囲
を、さらに多様に異なる向きに動くことができる。
【００１２】
【発明の実施の形態】以下、図１〜図１４に基づいて、
本発明の第１の実施の形態に係る内視鏡治療装置１を説
明する。
【００１３】内視鏡治療装置１は、図１に示すように、
体腔内を観察する内視鏡２、内視鏡２の観察下において
体腔内の病変部位に処置を施す２つの処置具３、これら
２つの処置具を１つずつ独立に内部に挿通して、体腔内
に誘導する２本の処置具誘導挿入具４、および内視鏡２
と２本の処置具誘導挿入具４とを内部に挿通して、体腔
内に誘導する１本の治療装置誘導チューブ体５などから
構成されている。
【００１４】治療装置誘導チューブ体５は、図１〜図
４、および図１４に示すように、その内部に、その長手
方向に沿って、その近位端から遠位端にわたって、治療
装置用管路としての、１本の内視鏡用チャンネル６およ
び２本の処置具誘導挿入具用チャンネル７を備えてい
る。治療装置誘導チューブ体５の遠位端面８には、図１
４に示すように、１本の内視鏡用チャンネル６の内視鏡
用チャンネル出口側開口部９および２本の処置具誘導挿
入具用チャンネル７のそれぞれの処置具誘導挿入具用チ
ャンネル出口側開口部１０が設けられている。
【００１５】内視鏡２は、図１〜図５に示すように、こ
れが備える可撓性を有する内視鏡挿入部１１を、治療装
置誘導チューブ体５の近位端から内視鏡用チャンネル６
の内部に挿通することにより、治療装置誘導チューブ体
５の長手方向に沿って摺動自在に取り付けられる。それ
とともに、内視鏡２は、治療装置誘導チューブ体５の周
方向に沿って回転自在に取り付けられる。
【００１６】このような取り付け方によれば、内視鏡２
の近位端部に設けられている後述する内視鏡操作部１９
を、治療装置誘導チューブ体５の長手方向に沿って摺動
させることにより、内視鏡挿入部１１の遠位端部は、内
視鏡用チャンネル出口側開口部９から突没自在に動くこ
とができる。よって、治療装置誘導チューブ体遠位端面
８から突出する内視鏡挿入部１１の遠位端部の長さを、
体腔の大きさに合わせて随時、任意の長さに調節するこ
とができる。また、内視鏡操作部１９を治療装置誘導チ
ューブ体５の径方向に沿って回転させることにより、内
視鏡２の視野内に捉えることのできる体腔内の映像のア
ングルを、随時、任意の見易い角度に調節することがで
きる。
【００１７】また、内視鏡挿入部１１の遠位端部には、
内視鏡操作部１９からの遠隔操作により、所定の向きに
湾曲する内視鏡湾曲部１２が設けられている。内視鏡２
は、これを使用する直前において、内視鏡挿入部１１の
内視鏡湾曲部１２から遠位側の部分が治療装置誘導チュ
ーブ体遠位端面８から突出される。
【００１８】内視鏡２はその内部に、体腔内を観察する
ための図示しない観察用光学装置、および体腔内を照ら
すための図示しない照明用光学装置などを備えている。
内視鏡２の遠位端面１３には、観察用光学装置および照
明用光学装置などのそれぞれの遠位端に備えられてい
る、観察用レンズ１４および照明用レンズ１５などが取
り付けられている。
【００１９】また、内視鏡２はその内部に、その長手方
向に沿って、その近位端部から遠位端にわたって、病変
部位の治療方法に応じた様々な内視鏡用処置具１６を挿
通して体腔内まで誘導する内視鏡用処置具用チャンネル
１７を備えている。本実施形態においては、内視鏡用処
置具としての電気メス１６が、内視鏡操作部１９に設け
られている内視鏡用処置具用チャンネル入口側開口部２
０から、内視鏡用処置具用チャンネル１７の内部にその
長手方向に沿って摺動自在に挿通されて取り付けられて
いる。それとともに、内視鏡用処置具用チャンネル１７
の内部には、電気メス１６が、内視鏡用処置具用チャン
ネル１７の径方向に沿って回転自在に挿通されて取り付
けられている。
【００２０】このような取り付け方によれば、電気メス
１６の近位端部に設けられている図示しない処置具操作
部としての電気メス操作部を、治療装置誘導チューブ体
５の長手方向に沿って摺動させることにより、電気メス
１６の遠位端部は、内視鏡用処置具用チャンネル出口側
開口部１８から突没自在に動くことができる。よって、
内視鏡遠位端面１３から突出する電気メス１６の遠位端
部の長さを、内視鏡遠位端面１３と体腔内の病変部位と
の距離に合わせて随時、任意の長さに調節することがで
きる。また、電気メス操作部を内視鏡用処置具用チャン
ネル１７の径方向に沿って回転させることにより、体腔
内の病変部位に対して、電気メス１６を、随時、任意の
治療し易い角度から操作することができる。この電気メ
ス１６は、図示しない電気メス操作部からの遠隔操作に
より、随時、作動させたり、あるいはその作動を停止さ
せたりすることができる。さらに、内視鏡２は、観察用
レンズ１４の表面を洗浄したり、体腔内へ送気したりす
る、同じく図示しない送水送気装置などを備えている。
【００２１】内視鏡２はその近位端に、図１、図４、お
よび図５に示すように、内視鏡２を遠隔操作するための
内視鏡操作部１９を備えている。内視鏡操作部１９に
は、内視鏡湾曲部１２を所定の向きに湾曲させるための
２つの内視鏡アングルノブ２１がそれぞれ独立に回転自
在に取り付けられている。これら２つの内視鏡アングル
ノブ２１のそれぞれは、図示しない複数本の内視鏡操作
ワイヤにより、互いに独立に内視鏡湾曲部１２と接続さ
れている。これらの内視鏡操作ワイヤは、内視鏡２の内
部をその近位端部から遠位端部まで、その長手方向に沿
って摺動自在に挿通されており、それぞれの近位端部
は、２つの内視鏡アングルノブ２１に接続されていると
ともに、それぞれの遠位端部は、内視鏡湾曲部１２の遠
位端部に固定されている。
【００２２】内視鏡アングルノブ２１を一方の向きに回
転させると、複数本の内視鏡操作ワイヤのうちの数本が
内視鏡２の長手方向に沿って遠位側に押し出される。そ
れとともに、複数本の内視鏡操作ワイヤのうちの残りの
数本が内視鏡２の長手方向に沿って近位側に引き戻され
る。内視鏡アングルノブ２１を他方の向きに逆回転させ
ると、複数本の内視鏡操作ワイヤは内視鏡２の長手方向
に沿ってそれぞれ先程とは逆の向きに摺動する。このよ
うな内視鏡操作ワイヤの摺動に対応して、内視鏡湾曲部
１２は所定の向きに湾曲する。この内視鏡湾曲部１２の
湾曲する向きを、例えば、一方の内視鏡アングルノブ２
１に対しては、その正逆回転に対応して、内視鏡挿入部
１１の直径を含む第１径方向とする。また、他方の内視
鏡アングルノブ２１に対しては、その正逆回転に対応し
て、先程の第１径方向に対して直交するとともに、内視
鏡挿入部１１の直径を含む第２径方向とする。すなわ
ち、内視鏡２をその遠位端面１３の正面方向から見た場
合、内視鏡挿入部１１の内視鏡湾曲部１２より遠位側の
部分は、２つの内視鏡アングルノブ２１のそれぞれの回
転操作に対応して、十字方向に湾曲するように設定す
る。内視鏡湾曲部１２の湾曲する向きをこのような設定
にすることにより、内視鏡遠位端面１３は内視鏡湾曲部
１２を中心として、略同一半径の球面上を動くことがで
きる。
【００２３】以上説明したような構成の内視鏡２によれ
ば、例えば、大腸や小腸などの長尺の体腔の内部に内視
鏡２を挿入しても、内視鏡２の周方向に沿った大腸や小
腸などの内壁を、その略正面方向から容易に観察するこ
とができる。それとともに、このような細長い体腔内に
できた病変部位をその略正面方向から、見易い距離およ
び見易い角度で観察しつつ、この病変部位に対して、内
視鏡２の視野内において、電気メス１６をその略正面方
向から操作することができる。
【００２４】また、内視鏡操作部１９には、観察用レン
ズ１４により捉えた体腔内の映像を図示しないモニタや
ビデオプロセッサーなどに出力するために、観察用光学
装置に接続したり、同じく図示しない光源装置を照明用
光学装置に接続したりするためのユニバーサルコード２
２が取り付けられている。さらに、内視鏡操作部１９に
は、前述した観察用光学装置、照明用光学装置、および
送水送気装置などを作動させたり、あるいはその作動を
停止させたりするため、あるいは観察用レンズ１４が捉
えた体腔内の映像を写真撮影するなど、各種画像処理を
するための複数のスイッチ２３が備えられている。
【００２５】２本の処置具誘導挿入具４は、図１〜図５
に示すように、内視鏡２の脇において、内視鏡２および
治療装置誘導チューブ体５のそれぞれの中心軸線を含む
とともにこれらを半分に縦断する面に対して、互いに略
対称に位置するように治療装置誘導チューブ体５に取り
付けられている。２本の処置具誘導挿入具４は、これら
がそれぞれ備えている可撓性を有する処置具誘導挿入具
挿入部２４を、治療装置誘導チューブ体５の近位端から
２本の処置具誘導挿入具用チャンネル７の内部にそれぞ
れ独立に挿通することにより、治療装置誘導チューブ体
５の長手方向に沿ってそれぞれ独立に摺動自在に取り付
けられている。それとともに、２本の処置具誘導挿入具
４は、治療装置誘導チューブ体５の周方向に沿ってそれ
ぞれ独立に回転自在に取り付けられている。
【００２６】このような取り付け方によれば、２本の処
置具誘導挿入具４のそれぞれの近位端部に設けられてい
る後述する処置具誘導挿入具操作部２５を、治療装置誘
導チューブ体５の長手方向に沿ってそれぞれ独立に摺動
させることにより、それぞれの処置具誘導挿入具挿入部
２４の遠位端部は、処置具誘導挿入具用チャンネル出口
側開口部１０からそれぞれ独立に突没自在に動くことが
できる。よって、治療装置誘導チューブ体遠位端面８か
ら突出するそれぞれの処置具誘導挿入具挿入部２４の遠
位端部の長さを、体腔の大きさに合わせてそれぞれ独立
に、随時、任意の長さに調節することができる。また、
それぞれの処置具誘導挿入具操作部２５を治療装置誘導
チューブ体５の径方向に沿ってそれぞれ独立に回転させ
ることにより、それぞれの処置具誘導挿入具挿入部２４
の遠位端部は、体腔内においてそれぞれ独立に回転する
ことができる。よって、２本の処置具誘導挿入具４のそ
れぞれが備えている後述する処置具誘導挿入具湾曲部２
８のそれぞれの湾曲する向きを、内視鏡挿入部１１に対
して互いに対称に保ったまま、２本の処置具誘導挿入具
４をそれぞれ独立に回転させることができる。それとと
もに、処置具誘導挿入具湾曲部２８のそれぞれの湾曲す
る向きを、治療装置誘導チューブ体５に対しても互いに
対称に保ったまま、２本の処置具誘導挿入具４をそれぞ
れ独立に回転させることができる。
【００２７】２本の処置具誘導挿入具４は、図６〜図１
１（ａ）、（ｂ）に示すように、それぞれの内部に、そ
れぞれの長手方向に沿って、それぞれの近位端部から遠
位端にわたって、病変部位の治療方法に応じた様々な処
置具３を１つずつ独立に挿通して体腔内まで誘導する処
置具用管路としての鉗子チャンネル２６を１本ずつ備え
ている。これら２本の鉗子チャンネル２６は、２本の処
置具誘導挿入具４のそれぞれの内部に、それらの長手方
向に沿って一体に取り付けられている処置具用チャンネ
ルチューブ体２７によってそれぞれ形成されている。こ
れら２本の処置具用チャンネルチューブ体２７は、可撓
性と所定の硬度とを兼ね備えている材質、例えば、フッ
素樹脂によって作られていることが好ましい。また、こ
れら２本の処置具用チャンネルチューブ体２７の処置具
誘導挿入具湾曲部２８と対向する部分には、処置具用チ
ャンネルチューブ体湾曲部２９がそれぞれ設けられてい
る。これらの処置具用チャンネルチューブ体湾曲部２９
の外周面には、図１０に示すように、湾曲部補強部材と
しての金属製の湾曲部保護ワイヤ３０が螺旋状に巻き付
けられて一体に固定されている。これにより、処置具用
チャンネルチューブ体湾曲部２９は、可撓性を損なうこ
となく、より高い耐久性を備えることができる。
【００２８】このような構造を有する処置具誘導挿入具
４によれば、処置具用チャンネルチューブ体湾曲部２９
が湾曲して、その外部に設けられている後述する湾曲駒
３１およびワイヤガイド３４などから圧迫を受けても、
湾曲部分において処置具用チャンネルチューブ体２７が
屈曲するおそれは殆どない。また、処置具用チャンネル
チューブ体湾曲部２９が湾曲した状態において、鉗子チ
ャンネル２６の内部に処置具３を挿入したり、あるいは
鉗子チャンネル２６の内部において処置具３を摺動させ
たりしても、湾曲部分において処置具３の動きが妨げら
れたり、処置具３によって処置具用チャンネルチューブ
体２７が破損させられたりするおそれも殆どない。
【００２９】また、２本の処置具誘導挿入具４のそれぞ
れの処置具誘導挿入具挿入部２４の遠位端部には、それ
ら２本の処置具誘導挿入具４のそれぞれの長手方向に沿
って、図１〜図３および図１１（ａ）、（ｂ）に示すよ
うに、処置具誘導挿入具操作部２５から遠隔操作するこ
とにより、所定の向きに湾曲する処置具誘導挿入具湾曲
部２８がそれぞれ２つずつ設けられている。それら４つ
の処置具誘導挿入具湾曲部２８は、図６に示すように、
それぞれの処置具誘導挿入具挿入部２４のより近位側に
設置されている２つの挿入具第１湾曲部２８ａと、図８
に示すように、それぞれの処置具誘導挿入具挿入部２４
のより遠位側に設置されている２つの挿入具第２湾曲部
２８ｂとから構成されている。２本の治療装置誘導挿入
具４は、これらを使用する直前において、それぞれの処
置具誘導挿入具挿入部２４に設けられている挿入具第１
湾曲部２８ａから遠位側の部分が、ともに治療装置誘導
チューブ体遠位端面８から突出される。
【００３０】挿入具第１湾曲部２８ａおよび挿入具第２
湾曲部２８ｂのそれぞれには、図６および図８に示すよ
うに、処置具誘導挿入具挿入部２４の内周面と処置具用
チャンネルチューブ体２７の外周面との間に、湾曲駒３
１がそれぞれ複数ずつ取り付けられている。これら複数
の湾曲駒３１のそれぞれは、２つ１組みに連結されてお
り、これら２つ１組みの湾曲駒３１同士は処置具誘導挿
入具４の長手方向に沿って、互いに等間隔に設置されて
いる。それとともに、これら２つ１組みの湾曲駒３１
は、処置具誘導挿入具４の内周面と処置具用チャンネル
チューブ体２７の外周面との間において、処置具用チャ
ンネルチューブ体２７の直径を含む径方向において略対
向するように設置されている。このように設置された湾
曲駒３１によれば、挿入具第１湾曲部２８ａおよび挿入
具第２湾曲部２８ｂが湾曲しても、処置具用チャンネル
チューブ体２７は処置具誘導挿入具挿入部２４と互いに
中心軸線を略同一に保ったまま、湾曲部分で屈曲するこ
となく滑らかに湾曲することができる。これにより、処
置具３を湾曲部分の途中で屈曲させることなく滑らかに
鉗子チャンネル２６の内部に挿通させたり、鉗子チャン
ネル２６の内部において摺動、および回転させたりする
ことができる。よって、処置具３の様々な動きによっ
て、鉗子チャンネル２６が傷つけられるおそれは殆どな
い。
【００３１】また、これら２つ１組みの湾曲駒３１のそ
れぞれの近位側の湾曲駒３１には、後述する２本の第１
湾曲部操作ワイヤ３２および２本の第２湾曲部操作ワイ
ヤ３３のそれぞれを、処置具誘導挿入具４の長手方向に
沿って円滑に案内するワイヤガイド３４がそれぞれ設け
られている。これらのワイヤガイド３４は、第１湾曲部
操作ワイヤ３２および第２湾曲部操作ワイヤ３３を、処
置具誘導挿入具４の内周面と処置具用チャンネルチュー
ブ体２７の外周面との略中間の位置において、処置具誘
導挿入具４の長手方向に沿って、それぞれ互いに独立に
摺動可能に支持する。それとともに、これら第１湾曲部
操作ワイヤ３２および第２湾曲部操作ワイヤ３３のそれ
ぞれの遠位端を、処置具誘導挿入具４の内周面のそれぞ
れの所定の取り付け位置まで誘導する。これらのワイヤ
ガイド３４により、挿入具第１湾曲部２８ａおよび挿入
具第２湾曲部２８ｂが湾曲しても、処置具誘導挿入具４
の内周面と処置具用チャンネルチューブ体２７の外周面
とにより、第１湾曲部操作ワイヤ３２および第２湾曲部
操作ワイヤ３３が圧迫されて、それらの動きが押し止め
られたりするおそれは殆どない。また、第１湾曲部操作
ワイヤ３２および第２湾曲部操作ワイヤ３３が、処置具
誘導挿入具挿入部２４の内周面や処置具用チャンネルチ
ューブ体２７の外周面と擦れ合って、互いに傷つけ合う
おそれも殆どない。
【００３２】２本の処置具誘導導入具４のそれぞれの内
部には、図６〜図９に示すように、それぞれの長手方向
に沿って、２本１組みからなる第１湾曲部操作ワイヤ３
２および第２湾曲部操作ワイヤ３３が、それぞれ１組ず
つ挿通されている。
【００３３】２本の第１湾曲部操作ワイヤ３２は、図６
および図７に示すように、２本の中空の第１コイルガイ
ド３７ａの内部に１本ずつ、それぞれ独立に摺動可能に
挿通されて、処置具誘導挿入具操作部２５から挿入具第
１湾曲部２８ａまで配設されている。２本の第１コイル
ガイド３７ａは、処置具誘導挿入具４の内周面と処置具
用チャンネルチューブ体２７の外周面との間において、
それらの長手方向に沿って処置具誘導挿入具操作部２５
から挿入具第１湾曲部２８ａの近位側まで延ばされて配
設されている。それとともに、２本の第１湾曲部操作ワ
イヤ３２のそれぞれの遠位端部は、処置具用チャンネル
チューブ体２７の直径を含む径方向において略対向する
ように、処置具誘導挿入具４の内周面に固定されてい
る。
【００３４】２本の第１湾曲部操作ワイヤ３２は、挿入
具第１湾曲部２８ａの最近位側に設けられている湾曲駒
３１の近位側において、第１コイルガイド３７ａからそ
れぞれ露出された後、ワイヤガイド３４によって挿入具
第１湾曲部２８ａの遠位側までそれぞれ独立に案内され
る。２本の第１湾曲部操作ワイヤ３２のそれぞれの遠位
端は、挿入具第１湾曲部２８ａの最遠位側に設けられて
いる湾曲駒３１の遠位側において、処置具用チャンネル
チューブ体２７の直径を含む径方向において対向するよ
うに、処置具誘導挿入具４の内周面に接着剤などによっ
て接着されて一体に固定される。また、これら２本の第
１湾曲部操作ワイヤ３２のそれぞれの近位端部は、処置
具誘導挿入具操作部２５に設けられている、挿入具第１
湾曲部２８ａを所定の向きに湾曲させるための後述する
第１湾曲部操作アングルノブ３５に接続されている。
【００３５】同様にして、２本の第２湾曲部操作ワイヤ
３３は、図６〜図９に示すように、２本の中空の第２コ
イルガイド３７ｂの内部にそれぞれ独立に摺動可能に挿
通されて、処置具誘導挿入具操作部２５から挿入具第２
湾曲部２８ｂまで配設されている。２本の第２コイルガ
イド３７ｂは、処置具誘導挿入具４の内周面と処置具用
チャンネルチューブ体２７の外周面との間において、そ
れらの長手方向に沿って処置具誘導挿入具操作部２５か
ら挿入具第２湾曲部２８ｂの近位側まで延ばされて配設
されている。それとともに、２本の第２湾曲部操作ワイ
ヤ３３のそれぞれの遠位端部は、処置具用チャンネルチ
ューブ体２７の直径を含む径方向において略対向するよ
うに、処置具誘導挿入具４の内周面に固定されている。
【００３６】２本の第２湾曲部操作ワイヤ３３は、挿入
具第２湾曲部２８ｂの最近位側に設けられている湾曲駒
３１の近位側において、第２コイルガイド３７ｂからそ
れぞれ露出された後、ワイヤガイド３４によって挿入具
第２湾曲部２８ｂの遠位側までそれぞれ独立に案内され
る。２本の第２湾曲部操作ワイヤ３３のそれぞれの遠位
端は、挿入具第２湾曲部２８ｂの最遠位側に設けられて
いる湾曲駒３１の遠位側において、処置具用チャンネル
チューブ体２７の直径を含む径方向において対向するよ
うに、処置具誘導挿入具４の内周面に接着剤などによっ
て接着されて一体に固定される。また、これら２本の第
２湾曲部操作ワイヤ３３のそれぞれの近位端部は、処置
具誘導挿入具操作部２５に設けられている、挿入具第２
湾曲部２８ｂを所定の向きに湾曲させるための後述する
第２湾曲部操作アングルノブ３６に接続されている。
【００３７】２本の処置具誘導挿入具４は、それぞれの
近位端に、図１、図４、および図５に示すように、これ
らの処置具誘導挿入具４を遠隔操作するための処置具誘
導挿入具操作部２５を備えている。これら２つの処置具
誘導挿入具操作部２５のそれぞれには、挿入具第１湾曲
部２８ａを所定の向きに湾曲させるための第１湾曲部操
作アングルノブ３５、および挿入具第２湾曲部２８ｂを
所定の向きに湾曲させるための第２湾曲部操作アングル
ノブ３６がそれぞれ独立に回転自在に取り付けられてい
る。前述したように、それぞれの第１湾曲部操作アング
ルノブ３５は、２本の第１湾曲部操作ワイヤ３２を介し
て、それぞれの挿入具第１湾曲部２８ａと接続されてい
る。また、同じく前述したように、それぞれの第２湾曲
部操作アングルノブ３６は、２本の第２湾曲部操作ワイ
ヤ３３を介して、それぞれの挿入具第２湾曲部２８ｂと
接続されている。
【００３８】第１湾曲部操作アングルノブ３５を、初期
の中立の位置から一方の向きに回転させると、２本の第
１湾曲部操作ワイヤ３２のうちの一本が処置具誘導挿入
具４の長手方向に沿って遠位側に押し出されるととも
に、残りの１本が処置具誘導挿入具４の長手方向に沿っ
て近位側に引き戻される。これに対応して、挿入具第１
湾曲部２８ａは、近位側に引き戻された第１湾曲部操作
ワイヤ３２の側に向かって湾曲する。また、第１湾曲部
操作アングルノブ３５を他方の向きに逆回転させると、
２本の第１湾曲部操作ワイヤ３２のそれぞれは、処置具
誘導挿入具４の長手方向に沿って先程とは逆向きに摺動
する。これに対応して、挿入具第１湾曲部２８ａは、先
程とは逆向きに湾曲する。
【００３９】同様にして、第２湾曲部操作アングルノブ
３６を、初期の中立の位置から一方の向きに回転させる
と、２本の第２湾曲部操作ワイヤ３３のうちの一本が処
置具誘導挿入具４の長手方向に沿って遠位側に押し出さ
れるとともに、残りの１本が処置具誘導挿入具４の長手
方向に沿って近位側に引き戻される。これに対応して、
挿入具第２湾曲部２８ｂは、近位側に引き戻された第２
湾曲部操作ワイヤ３３の側に向かって湾曲する。また、
第２湾曲部操作アングルノブ３６を他方の向きに逆回転
させると、２本の第２湾曲部操作ワイヤ３３のそれぞれ
は、処置具誘導挿入具４の長手方向に沿って先程とは逆
向きに摺動する。これに対応して、挿入具第２湾曲部２
８ｂは、先程とは逆向きに湾曲する。
【００４０】本実施形態においては、第１湾曲部操作ア
ングルノブ３５および第２湾曲部操作アングルノブ３６
のそれぞれを初期の中立の位置に保持している場合に
は、挿入具第１湾曲部２８ａおよび挿入具第２湾曲部２
８ｂは、図１１（ａ）に示すように、処置具誘導挿入具
４の長手方向に沿って、ともに一直線状に延びた状態に
なるように設定されている。処置具誘導挿入具４を処置
具誘導挿入具用チャンネル７の内部に挿通させて治療装
置誘導チューブ体５に取り付けるとき、あるいは治療装
置誘導チューブ体５から引き抜くときなどは、挿入具第
１湾曲部２８ａおよび挿入具第２湾曲部２８ｂのそれぞ
れが、このように一直線状に延びた状態で行なうことが
好ましい。
【００４１】第１湾曲部操作アングルノブ３５および第
２湾曲部操作アングルノブ３６のそれぞれを独立に、互
いに逆向きに回転させた場合には、挿入具第１湾曲部２
８ａおよび挿入具第２湾曲部２８ｂは、図１１（ｂ）に
示すように、処置具用チャンネルチューブ体２７の直径
を含む径方向において、互いに略逆向きに湾曲するよう
に設定されている。すなわち、挿入具第１湾曲部２８ａ
および挿入具第２湾曲部２８ｂは、処置具誘導挿入具４
の長手方向に沿って、略Ｓ字形に湾曲するように設定さ
れている。また、第１湾曲部操作アングルノブ３５およ
び第２湾曲部操作アングルノブ３６のそれぞれを先程と
は反対の向きに、互いに独立に、かつ逆向きに回転させ
て初期の中立の位置に戻した場合には、挿入具第１湾曲
部２８ａおよび挿入具第２湾曲部２８ｂのそれぞれは、
処置具誘導挿入具４の長手方向に沿って、初期の一直線
状に延びた状態に戻るように設定されている。さらに、
２本の処置具誘導挿入具４のそれぞれの挿入具第１湾曲
部２８ａは、それぞれの第１湾曲部操作アングルノブ３
５を同一の向きに回転させたときに、互いに対称な向き
に湾曲するように設定されている。同様に、２本の処置
具誘導挿入具４のそれぞれの挿入具第２湾曲部２８ｂ
も、それぞれの第２湾曲部操作アングルノブ３６を同一
の向きに回転させたときに、互いに対称な向きに湾曲す
るように設定されている。
【００４２】このような設定によれば、この内視鏡治療
装置１を用いて病変部位の治療を行なう術者などは、２
本の処置具誘導挿入具４のそれぞれの第１湾曲部操作ア
ングルノブ３５同士、および第２湾曲部操作アングルノ
ブ３６同士を、それぞれともに同じ向きに回転させるこ
とによって、それぞれの挿入具第１湾曲部２８ａ同士、
および挿入具第２湾曲部２８ｂ同士を、それぞれ互いに
対称な向きに湾曲させることができる。これにより、術
者などは、第１湾曲部操作アングルノブ３５同士、およ
び第２湾曲部操作アングルノブ３６同士を、それぞれ互
いに反対の向きに回転させるような回転操作に煩わされ
ることがない。すなわち、術者などが、内視鏡２から送
られてくる体腔内の映像を見たままの状態でも、２本の
処置具誘導治療装置４の遠隔操作を容易に行なうことが
できるので、病変部位の治療に専念し易くなる。
【００４３】なお、図１１（ａ）および（ｂ）において
は、図面を見易くするために、２本の第１湾曲部操作ワ
イヤ３２および２本の第２湾曲部操作ワイヤ３３をそれ
ぞれ１本ずつのみ図示するとともに、複数の湾曲駒３１
などはその図示を省略する。
【００４４】本実施形態においては、図３に示すよう
に、２本の処置具誘導挿入具４のそれぞれの挿入具第１
湾曲部２８ａが、内視鏡治療装置１の長手方向に沿っ
て、治療装置誘導チューブ体遠位端面８から同じ距離に
位置するように、２本の処置具誘導挿入具４を治療装置
誘導チューブ体５に取り付けることが好ましい。このよ
うな取り付け方によれば、内視鏡遠位端面１３の前方に
おいて、２つの処置具３を略等しい位置で操作すること
ができる。また、２本の処置具誘導挿入具４のそれぞれ
の挿入具第１湾曲部２８ａから遠位側の部分が、互いに
対称性を保ちつつ、ともに内視鏡２から離れる向きに反
り返るように、２本の処置具誘導挿入具４を治療装置誘
導チューブ体５にそれぞれ独立に取り付けることが好ま
しい。
【００４５】このような取り付け方によれば、挿入具第
２湾曲部２８ｂは、挿入具第１湾曲部２８ａと略反対向
きに湾曲するように設定されているので、内視鏡遠位端
面１３の前方において、２つの処置具３は、互いに対称
性を保ちつつ、それぞれ独立に近付くことができる。よ
って、内視鏡遠位端面１３の前方において、内視鏡２の
長手方向に対する、２つの処置具３の操作角度を大きく
取ることができる。これにより、体腔内の病変部位に対
する内視鏡２の視界を妨げることなく、病変部位の治療
方法に応じた適切な方向から２つの処置具３を操作しつ
つ、電気メス１６を操作して、病変部位に適切な治療を
容易に施すことができる。
【００４６】なお、体腔内における内視鏡２の湾曲の向
き、あるいは体腔内における病変部位の位置などに応じ
て、治療装置誘導チューブ体５に対する２本の処置具誘
導挿入具４のそれぞれの取り付け方を変えても構わな
い。すなわち、処置具誘導挿入具用チャンネル７の内部
において、その長手方向に沿って２本の処置具誘導挿入
具４のそれぞれを互いに独立に摺動させて、それぞれの
挿入具第１湾曲部２８ａの位置をずらしても構わない。
また、処置具誘導挿入具用チャンネル７の内部におい
て、その周方向に沿って２本の処置具誘導挿入具４のそ
れぞれを互いに独立に回転させて、それぞれの挿入具第
１湾曲部２８ａの湾曲する向きを互いに対称な向きから
ずらしても構わない。
【００４７】また、２つの処置具誘導挿入具操作部２５
のそれぞれには、図１、図４、および図５に示すよう
に、鉗子チャンネル２６の入口側開口部３８が１つずつ
設けられている。本実施形態においては、２つの鉗子チ
ャンネル２６のそれぞれ内部には、処置具としての鉗子
３が１つずつ挿通されて取り付けられている。２つの鉗
子３は、２つの鉗子チャンネル入口側開口部３８から鉗
子チャンネル２６の内部にそれぞれ独立に挿通されて、
処置具誘導挿入具４の遠位端面３９に設けられている鉗
子チャンネル出口側開口部４０を経て、２本の処置具誘
導挿入具４の外部にそれぞれ独立に突没自在に取り付け
られている。これら２つの鉗子３は、鉗子チャンネル２
６の長手方向に沿って摺動自在に挿通されて取り付けら
れている。それとともに、これら２つの鉗子３は、鉗子
チャンネル２６の径方向に沿って回転自在に挿通されて
取り付けられている。
【００４８】このような取り付け方によれば、２つの鉗
子操作部４１を、２本の鉗子チャンネル２６の長手方向
に沿ってそれぞれ独立に摺動させることにより、処置具
誘導挿入具遠位端面３９から突出する２つの鉗子３のそ
れぞれの遠位端部の長さを、処置具誘導挿入具遠位端面
３９と体腔内の病変部位との距離に合わせて互いに独立
に随時、任意の長さに調節することができる。また、２
つの鉗子操作部４１を、２本の鉗子チャンネル２６のそ
れぞれの周方向に沿ってそれぞれ独立に回転させること
により、体腔内の病変部位に対して、２つの鉗子３を互
いに独立に、随時、任意の治療し易い角度から操作する
ことができる。また、２つの鉗子３は、それぞれの鉗子
操作部４１から遠隔操作することにより、互いに独立
に、随時、それらの開口を開閉することができる。
【００４９】以上説明した構成からなる、本実施形態の
内視鏡治療装置１によれば、体腔の大きさや形状、およ
び体腔内の病変部位の位置に応じて、治療装置誘導チュ
ーブ体５から突出される内視鏡２、２本の処置具誘導導
入具４、および２つの鉗子３のそれぞれの長さや向き
を、それぞれ独立に、随時、任意の治療し易い位置に合
わせることができる。これにより、病変部位を観察する
内視鏡２の視界を妨げることなく、最も治療し易い位置
から病変部位の治療を容易に行なうことができる。よっ
て、治療を行なう術者の負担を低減できるとともに、治
療にかかる時間も短縮でき、ひいては治療される患者の
負担も低減できる。
【００５０】次に、本実施形態の内視鏡治療装置１を用
いた病変部位の治療方法について、その概略を説明す
る。
【００５１】まず、治療に先立って、内視鏡操作部１９
および２つの処置具誘導挿入具操作部２５のそれぞれ
を、図５に示すように、内視鏡治療装置操作部用架台４
２に取り付ける。このとき、内視鏡操作部１９を中心と
して、その両側に処置具誘導挿入具操作部２５を１つず
つ取り付ける。また、このような内視鏡操作部１９およ
び２つの処置具誘導挿入具操作部２５のそれぞれの配置
関係を保ちつつ、治療装置誘導チューブ体５の内部にお
いて、内視鏡２を中心として、２本の治療装置誘導チュ
ーブ体５が互いに交錯しないように、内視鏡２および２
つの処置具誘導挿入具４のそれぞれを、治療装置誘導チ
ューブ体５の内部に配置して取り付ける。例えば、この
内視鏡治療装置１を、その長手方向に沿って近位側から
見た場合、内視鏡操作部１９の一方の側に取り付けた処
置具誘導挿入具操作部２５を有する処置具誘導挿入具４
は、治療装置誘導チューブ体５の内部において、内視鏡
２の一方の側に、その長手方向に沿って位置するように
取り付ける。これと同様にして、内視鏡操作部１９の他
方の側に取り付けた処置具誘導挿入具操作部２５を有す
る処置具誘導挿入具４は、内視鏡２の他方の側に、その
長手方向に沿って位置するように取り付ける。
【００５２】このような取り付け方法、および配置方法
によれば、内視鏡操作部１９、あるいは２つの処置具誘
導挿入具操作部２５のそれぞれを、治療中に術者が自分
の手で保持している必要がなくなるので、術者の負担を
低減できる。よって、術者は治療行為に専念することが
できる。また、治療装置誘導チューブ体５の内部におい
て、前述のように一方の側に配置されて取り付けられた
処置具誘導挿入具操作部２５を有する処置具誘導挿入具
４は、内視鏡２から送られてくる体腔内の映像におい
て、電気メス１６を中心として、一方の側に配置され
る。それとともに、他方の側に配置されて取り付けられ
た処置具誘導挿入具操作部２５を有する処置具誘導挿入
具４は、内視鏡２から送られてくる体腔内の映像におい
て、電気メス１６を中心として、他方の側に配置され
る。よって、術者は治療中に、２本の処置具誘導挿入具
４、ひいてはこれら２本の処置具誘導挿入具４のそれぞ
れに１つずつ挿通されて用いられる２つの鉗子３のそれ
ぞれの、互いに独立した遠隔操作に煩わされたり、それ
らの遠隔操作を混同するおそれが低い。このため、病変
部位を正確に、かつ手際よく治療することができる。
【００５３】内視鏡治療装置１を、図５および図１２に
示すように、患者の口腔から体腔内、例えば、胃の中に
挿入する。先ず、内視鏡操作部１９から遠隔操作するこ
とにより、内視鏡２で胃の中を観察して目的の切除すべ
き病変部位を探す。目的の切除すべき病変部位を発見し
た後、治療装置誘導チューブ体５から突出する内視鏡挿
入部１１の長さや、内視鏡湾曲部１２の湾曲する向きな
どを内視鏡操作部１９で調節するなどして、図１３に示
すように、病変部位を適度な大きさで内視鏡２の視野の
中央付近において捉えるように、内視鏡遠位端面１３を
病変部位の直前の略正面において対向する位置まで誘導
して配置する。内視鏡用処置具用チャンネル１７に電気
メス１６を挿通して、内視鏡用処置具用チャンネル出口
側開口部１８から突出させる。
【００５４】次に、２つの処置具誘導挿入具操作部２５
から遠隔操作することにより、治療装置誘導チューブ体
５から突出する２本の処置具誘導挿入具４のそれぞれの
処置具誘導挿入具挿入部２４の長さや、２本の処置具誘
導挿入具４のそれぞれの挿入具第１湾曲部２８ａおよび
挿入具第２湾曲部２８ｂの湾曲する向きなどを調節する
などして、図１３に示すように、それぞれの処置具誘導
挿入具遠位端面３９が電気メス１６を中心として、互い
に略対称な向きから病変部位に近付くように、病変部位
の直ぐ側にそれぞれ誘導して配置する。２本の処置具誘
導挿入具４のそれぞれの鉗子チャンネル２６に鉗子３を
１つずつ挿通させて、鉗子チャンネル出口側開口部４０
から突出させた後、それぞれの鉗子操作部４１から遠隔
操作することにより、２つの鉗子３で病変部位を把持す
る。電気メス１６で切除し易いように、２つの鉗子３で
病変部位を引き延ばすように把持して、電気メス操作部
から遠隔操作することにより、電気メス１６で病変部位
を切除する。生体組織の切除部分に縫合などの所定の治
療を行なった後、患者の体腔内から内視鏡治療装置１を
引出して、病変部位の治療を終了とする。
【００５５】以上説明した治療法方によれば、術者が自
分の肉眼で病変部位を直接観察しつつ、自分の両手で病
変部位の切除を直接行なうのと略同様の感覚、および要
領で病変部位の治療を行なうことができる。よって、体
腔の大きさや形状、および体腔内の病変部位の位置に拘
わらずに、容易に、正確に、かつ迅速に病変部位を治療
することができる。
【００５６】次に、図１５〜図１７に基づいて、本発明
の第２の実施の形態に係る内視鏡治療装置１を説明す
る。
【００５７】この第２実施形態の内視鏡治療装置１は、
これが備える治療装置誘導チューブ体５の遠位端面８に
設けられている、治療装置用管路１０１の出口側開口部
１０２の形状、作用、および効果が、前述の第１実施形
態の治療装置用管路としての内視鏡用チャンネル６の出
口側開口部９および処置具誘導挿入具用チャンネル７の
出口側開口部１０のそれぞれのものと若干異なっている
だけで、その他の構成、作用、および効果はすべて同じ
である。よって、その異なっている部分だけについて説
明し、その他のすべての説明は省略する。
【００５８】また、図面についても、内視鏡操作部１９
および２つの処置具誘導挿入具操作部２５の外観斜視図
をはじめとする、同一の構成部分の図面は省略し、本実
施形態の治療装置用管路１０１の出口側開口部１０２の
特徴をよく理解することのできる図面のみを示し、これ
らの図１５〜図１７において、前述の第１実施形態と同
一部分には同一符号を付してある。
【００５９】本実施形態の治療装置用管路１０１の出口
側開口部１０２は、図１５に示すように、内視鏡２が突
出する部分と、２本の処置具誘導挿入具４のそれぞれが
突出する部分とが一体に形成されている。治療装置用管
路出口側開口部１０２には、内視鏡２と２本の処置具誘
導挿入具４のそれぞれとの間、および２本の処置具誘導
挿入具４同士の間を仕切る管路仕切り凸部１０３が３箇
所に設けられている。治療装置用管路１０１に挿通され
て、治療装置用管路出口側開口部１０２から突出される
内視鏡２および２本の処置具誘導挿入具４のそれぞれ
は、管路仕切り凸部１０３によって、互いに位置を規制
される。これにより、治療装置誘導チューブ体遠位端面
８に、内視鏡２および２本の処置具誘導挿入具４のそれ
ぞれに１つずつ対応する開口部を独立に３箇所も設ける
ことなく、前述の第１実施形態と同様に、治療装置誘導
チューブ体５の内部において、内視鏡２と２本の処置具
誘導挿入具４とをそれぞれ所定の位置に配置することが
できる。それとともに、内視鏡２と２本の処置具誘導挿
入具４のそれぞれを、治療装置用管路１０１の内部にお
いて、その長手方向に沿って、摺動自在に保持すること
ができる。また、治療装置用管路１０１の内部におい
て、その周方向に沿って、回転自在に保持することがで
きる。
【００６０】この第２実施形態の内視鏡用処置具１は、
以上説明した点以外は、すべて第１実施形態の内視鏡用
処置具１と同じであるので、この第２実施形態の内視鏡
用処置具１を用いることにより、本発明の課題を解決で
きるのは勿論であるが、前記形状の治療装置用管路出口
側開口部１０２を備えた第２実施形態は、以下の点で優
れている。
【００６１】治療装置用管路出口側開口部１０２が一つ
の開口としてまとめられており、その加工、および形成
がし易いので、これを有する治療装置誘導チューブ体５
を容易に製造することができる。また、治療装置用管路
出口側開口部１０２において、治療装置用管路１０１と
内視鏡２および２本の処置具誘導挿入具４のそれぞれと
の間の空間に余裕があるために、内視鏡２および２本の
処置具誘導挿入具４のそれぞれを、治療装置用管路１０
１の長手方向に沿って、容易に摺動させることができ
る。それとともに、治療装置用管路１０１の周方向に沿
って、容易に回転させることができる。よって、体腔の
形状、大きさ、および体腔内の病変部位の位置に合わせ
て、内視鏡２および２本の処置具誘導挿入具４のそれぞ
れを、治療装置誘導チューブ体５ごと体腔内で移動させ
ることなく、内視鏡２の視野内に病変部位が適切な大き
さで映る位置、および病変部位を治療する際に内視鏡２
の視界を妨げるおそれのない適切な位置に、内視鏡２お
よび２つの鉗子３のそれぞれを容易に位置させることが
できる。また、治療装置誘導チューブ体５ごと体腔内で
回転させることなく、病変部位の治療方法に応じた適切
な向きから、内視鏡２および２つの鉗子３のそれぞれを
容易に操作することができる。すなわち、体腔の大きさ
や形状、および体腔内の病変部位の位置に拘わらずに、
より容易に、より正確に、かつより迅速に病変部位を治
療することができる。
【００６２】次に、図１８〜図２８に基づいて、本発明
の第３の実施の形態に係る内視鏡治療装置１を説明す
る。
【００６３】この第３実施形態の内視鏡治療装置１は、
これが備える２本の処置具誘導挿入具２０１のそれぞれ
の構成、作用、および効果が、前述の第１実施形態の２
本の処置具誘導挿入具４のそれぞれのものと若干異なっ
ているだけで、その他の構成、作用、および効果はすべ
て同じである。よって、その異なっている部分だけにつ
いて説明し、その他のすべての説明は省略する。
【００６４】また、図面についても、治療装置誘導チュ
ーブ体５の外観斜視図をはじめとする、同一の構成部分
の図面は省略し、本実施形態の２本の処置具誘導挿入具
２０１のそれぞれの特徴をよく理解することのできる図
面のみを示し、これらの図１８〜図２８において、前述
の第１実施形態と同一部分には同一符号を付してある。
【００６５】本実施形態の２本の処置具誘導挿入具２０
１のそれぞれの挿入部２０８の遠位端部には、図１８お
よび図１９に示すように、それらの長手方向に沿って、
それぞれ近位側から順に、処置具誘導挿入具湾曲部２８
としての挿入具第１湾曲部２８ａ、挿入具第２湾曲部２
８ｂ、および挿入具第３湾曲部２０２が設けられてい
る。これら挿入具第１湾曲部２８ａ、挿入具第２湾曲部
２８ｂ、および挿入具第３湾曲部２０２のそれぞれは、
互いに所定の間隔をおいて設けられている。
【００６６】２本の処置具誘導挿入具２０１のそれぞれ
の内部には、前述の第１実施形態と同様に、図２１〜図
２６に示すように、第１コイルガイド３７ａに挿通され
ている第１湾曲部操作ワイヤ３２、および第２コイルガ
イド３７ｂに挿通されている第２湾曲部操作ワイヤ３３
がそれぞれ２本１組みずつ挿通されて取り付けられてい
る。それとともに、第３コイルガイド２０３に挿通され
ている第３湾曲部第１方向操作ワイヤ２０４、および同
じく第３コイルガイド２０３に挿通されている第３湾曲
部第２方向操作ワイヤ２０５がそれぞれ２本１組みずつ
挿通されて取り付けられている。
【００６７】また、２本の処置具誘導挿入具２０１のそ
れぞれの処置具誘導挿入具操作部２５には、前述の第１
実施形態と同様に、挿入具第１湾曲部２８ａを遠隔操作
するための第１湾曲部操作アングルノブ３５、および挿
入具第２湾曲部２８ｂを遠隔操作するための第２湾曲部
操作アングルノブ３６がそれぞれ１つずつ取り付けられ
ている。それとともに、挿入具第３湾曲部２０２を遠隔
操作することにより後述する第１方向に湾曲させるため
の第３湾曲部第１方向操作アングルノブ２０６、および
挿入具第３湾曲部２０２を遠隔操作することにより後述
する第２方向に湾曲させるための第３湾曲部第２方向操
作アングルノブ２０７がそれぞれ１つずつ取り付けられ
ている。
【００６８】それら２つの第３湾曲部第１方向操作アン
グルノブ２０６のそれぞれは、２本１組みの第３湾曲部
第１方向操作ワイヤ２０４を介して、それぞれの挿入具
第３湾曲部２０２と接続されている。同じく２つの第３
湾曲部第２方向操作アングルノブ２０７のそれぞれは、
２本１組みの第３湾曲部第２方向操作ワイヤ２０５を介
して、それぞれの挿入具第３湾曲部２０２と接続されて
いる。
【００６９】それぞれの第３湾曲部第１方向操作アング
ルノブ２０６を一方向に正回転、あるいは他方向に逆回
転させると、それぞれの挿入具第３湾曲部２０２が、図
２７中実線矢印Ａで示す第１方向に沿って湾曲する。ま
た、それぞれの第３湾曲部第２方向操作アングルノブ２
０７を一方の向きに正回転、あるいは他方の向きに逆回
転させると、それぞれの挿入具第３湾曲部２０２が、図
２７および図２８中実線矢印Ｂで示す第２方向に沿って
湾曲する。本実施形態においては、これらの第１方向と
第２方向とは、互いに直交するように設定されている。
このため、２本の処置具誘導挿入具２０１のそれぞれの
遠位端面３９は、それぞれの挿入具第３湾曲部２０２を
中心として、略同一半径の球面上を動くことができる。
また、それぞれの挿入具第３湾曲部２０２は、それぞれ
の第３湾曲部第１方向操作アングルノブ２０６、および
それぞれの第３湾曲部第２方向操作アングルノブ２０７
を同じ向きに回転させた場合、互いに対称な向きに湾曲
するように予め設定されている。
【００７０】この第３実施形態の内視鏡用処置具１は、
以上説明した点以外は、すべて第１実施形態の内視鏡用
処置具１と同じであるので、この第３実施形態の内視鏡
用処置具１を用いることにより、本発明の課題を解決で
きるのは勿論であるが、前記構成の２本の処置具誘導挿
入具２０１を備えた第３実施形態は、以下の点で優れて
いる。
【００７１】２本の処置具誘導挿入具２０１のそれぞれ
に、挿入具第１湾曲部２８ａ、挿入具第２湾曲部２８
ｂ、および挿入具第３湾曲部２０２を互いに所定の間隔
をおいて設けたので、それぞれの挿入具第１湾曲部２８
ａより遠位側の処置具誘導挿入具挿入部２０８の可動範
囲をより広くすることができる。それとともに、それぞ
れの挿入具第３湾曲部２０２は、互いに直交する２方向
に沿って湾曲することができるので、体腔内の病変部位
の位置に拘わらずに、内視鏡２の視界を妨げるおそれが
さらに低く、病変部位の治療方法に応じて、さらに適切
な向きから鉗子３を操作することができる。すなわち、
体腔の大きさや形状、および体腔内の病変部位の位置に
拘わらずに、さらに容易に、さらに正確に、かつさらに
迅速に病変部位を治療することができる。
【００７２】次に、図２９および図３０に基づいて、本
発明の第４の実施の形態に係る内視鏡治療装置１を説明
する。
【００７３】この第４実施形態の内視鏡治療装置１は、
これが備える２本の処置具誘導挿入具２０１のそれぞれ
の構成、作用、および効果が、前述の第１実施形態の２
本の処置具誘導挿入具４のそれぞれのものと若干異なっ
ているだけで、その他の構成、作用、および効果はすべ
て同じである。それとともに、この第４実施形態の内視
鏡治療装置１が備える治療装置誘導チューブ体５の遠位
端面８に設けられている、治療装置用管路１０１の出口
側開口部１０２の形状、作用、および効果が、前述の第
１実施形態の２本の処置具誘導挿入具４のそれぞれのも
のと若干異なっているだけで、その他の形状、作用、お
よび効果はすべて同じである。よって、それらの異なっ
ている部分だけについて説明し、その他のすべての説明
は省略する。
【００７４】また、図面についても、内視鏡操作部１９
および２つの処置具誘導挿入具操作部２５の外観斜視図
をはじめとする、略同一の構成部分の図面は省略し、本
実施形態の２本の処置具誘導挿入具２０１および治療装
置用管路１０１の出口側開口部１０２の特徴をよく理解
することのできる図面のみを示し、これらの図２９およ
び図３０において、前述の第１実施形態と同一部分には
同一符号を付してある。
【００７５】本実施形態の２本の処置具誘導挿入具２０
１は、前述の第３実施形態に用いられているものと同一
の構成のものであり、それぞれの挿入部２０８の遠位端
部には、図１８および図１９に示すように、それらの長
手方向に沿って、それぞれ近位側から順に、処置具誘導
挿入具湾曲部２８としての挿入具第１湾曲部２８ａ、挿
入具第２湾曲部２８ｂ、および挿入具第３湾曲部２０２
が設けられている。これら挿入具第１湾曲部２８ａ、挿
入具第２湾曲部２８ｂ、および挿入具第３湾曲部２０２
のそれぞれは、互いに所定の間隔をおいて設けられてい
る。また、本実施形態の治療装置用管路１０１の出口側
開口部１０２は前述の第２実施形態のものと同一の形状
のものであり、内視鏡２が突出する部分と、２本の処置
具誘導挿入具４のそれぞれが突出する部分とが一体に形
成されている。治療装置用管路出口側開口部１０２に
は、内視鏡２と２本の処置具誘導挿入具４のそれぞれと
の間、および２本の処置具誘導挿入具４同士の間を仕切
る管路仕切り凸部１０３が３箇所に設けられている。
【００７６】この第４実施形態の内視鏡用処置具１は、
以上説明した点以外は、すべて第１実施形態の内視鏡用
処置具１と同じであるので、この第４実施形態の内視鏡
用処置具１を用いることにより、本発明の課題を解決で
きるのは勿論であるが、前記構成の２本の処置具誘導挿
入具２０１および前記形状の治療装置用管路出口側開口
部１０２を備えた第４実施形態は、以下の点で優れてい
る。
【００７７】２本の処置具誘導導入具２０１のそれぞれ
に、挿入具第１湾曲部２８ａ、挿入具第２湾曲部２８
ｂ、および挿入具第３湾曲部２０２を互いに所定の間隔
をおいて設けたので、それぞれの挿入具第１湾曲部２８
ａより遠位側の処置具誘導挿入具挿入部２０８の可動範
囲をより広くすることができる。それとともに、それぞ
れの挿入具第３湾曲部２０２は、互いに直交する２方向
に沿って湾曲することができるので、それぞれの処置具
誘導挿入具挿入部２０８の鉗子チャンネル出口側開口部
４０から突出させられる２つの鉗子３のそれぞれの位置
を、より様々な向きから、より細かく操作することがで
きる。また、治療装置用管路出口側開口部１０２におい
て、治療装置用管路１０１と内視鏡２および２本の処置
具誘導挿入具４のそれぞれとの間の空間に余裕があるた
めに、内視鏡２および２本の処置具誘導挿入具４のそれ
ぞれを、治療装置用管路１０１の長手方向に沿って、容
易に摺動させることができる。それとともに、治療装置
用管路１０１の周方向に沿って、容易に回転させること
ができる。よって、体腔の大きさや形状、および体腔内
の病変部位の位置に拘わらずに、極めて容易に、極めて
正確に、かつ極めて迅速に病変部位を治療することがで
きる。
【００７８】なお、本発明の内視鏡治療装置１は、前記
第１〜第４の実施の形態には制約されない。
【００７９】前記第１〜第４の実施の形態に係る内視鏡
治療装置１によれば、例えば、以下のような構成を得る
ことができる。
【００８０】（付記１）可撓性を有する挿入部１２を備
えた内視鏡２と、この内視鏡２による観察下において使
用する複数の処置具３と、これら複数の処置具３のうち
少なくとも２つを独立に挿通して体腔内に誘導する処置
具用管路２６を備えるとともに、可撓性を有する挿入部
２４を備えた２本の処置具誘導挿入具４と、前記内視鏡
２および前記２本の処置具誘導挿入具４のそれぞれの挿
入部１２，２４を体腔内に誘導するとともに、前記２本
の処置具誘導挿入具４のそれぞれの挿入部２４を前記内
視鏡２の挿入部１２に対して互いに所定の対称位置に配
置する治療装置用管路６，７を備える治療装置誘導チュ
ーブ体５とを具備し、前記２本の処置具誘導挿入具４の
それぞれの挿入部２４の遠位端部には、前記２本の処置
具誘導挿入具４のそれぞれの近位端部から遠隔操作する
ことにより、前記内視鏡２の挿入部１２に対して互いに
所定の対称な向きに湾曲させられる湾曲部２８が設けら
れていることを特徴とする内視鏡治療装置１。
【００８１】（付記２）前記２本の処置具誘導挿入具４
のそれぞれの挿入部２４の遠位端部に、その長手方向に
沿って、互いに対向する位置に前記湾曲部２８をそれぞ
れ複数ずつ設置するとともに、互いに対向する位置に設
置された前記複数の湾曲部２８ごとに、それぞれ異なる
所定の対称な向きに、前記内視鏡２の挿入部１２に対し
て互いに湾曲することを特徴とする付記１に記載の内視
鏡治療装置１。
【００８２】（付記３）前記複数の湾曲部２８のうち、
それぞれの最近位側に設置された前記湾曲部２８ａは、
これらの最近位側に設置された湾曲部２８ａより遠位側
の前」記２本の処置具誘導挿入具のそれぞれの挿入部２
４の長手方向が、ともに前記内視鏡２の挿入部１２の長
手方向に対して乖離および接近する方向に沿って、互い
に対称な向きに湾曲することを特徴とする付記２に記載
の内視鏡治療装置１。
【００８３】（付記４）治療装置誘導チューブ体５が備
える治療装置用管路６，７は、前記内視鏡２の挿入部１
２と、前記２本の処置具誘導挿入具４のそれぞれの挿入
部２４とを、それらの長手方向に沿って、それぞれ独立
に、かつ互いに略平行に誘導して体腔内に挿入する独立
した複数の治療装置用管路６，７からなることを特徴と
する付記１〜付記３のうちのいずれか１つに記載の内視
鏡治療装置１。
【００８４】（付記５）治療装置誘導チューブ体５が備
える治療装置用管路６，７は、前記内視鏡２の挿入部１
２と、前記２本の処置具誘導挿入具４のそれぞれの挿入
部２４とを、それらの長手方向に沿って、互いに略平行
に誘導して体腔内に挿入する１つの治療装置用管路１０
１からなることを特徴とする付記１〜付記３のうちのい
ずれか１つに記載の内視鏡治療装置１ （付記６）前記２本の処置具誘導挿入具４のそれぞれが
備える処置具用管路２６は、可撓性を有するとともに、
所定の硬度を有するフッ素樹脂により形成されることを
特徴とする付記１〜付記５に記載の内視鏡治療装置１。
【００８５】（付記７）前記２本の処置具誘導挿入具４
のそれぞれが備える処置具用管路２６を形成する処置具
用チャンネルチューブ体２７の湾曲部２９の外周面に
は、湾曲部補強部材３０が取り付けられていることを特
徴とする付記１〜付記６に記載の内視鏡治療装置１。
【００８６】
【発明の効果】請求項１〜３に記載の発明に係る内視鏡
治療装置によれば、２本の処置具誘導挿入具のそれぞれ
を、内視鏡に対して互いに対称な位置に配置するととも
に、２本の処置具誘導挿入具のそれぞれの挿入部の遠位
端部に設けられている湾曲部のそれぞれを、内視鏡の挿
入部に対して、互いに所定の対称な向きに湾曲させるこ
とができる。これにより、２本の処置具誘導挿入具のそ
れぞれに独立に挿通、かつ誘導されて、体腔内に突出さ
れる複数の処置具のそれぞれを、ともに内視鏡の視界を
殆ど妨げることなく、かつ、互いに相手の可動範囲を制
限することなく、内視鏡を挟んで、その両側の対称な向
きから遠隔操作することができる。よって、体腔内にお
いて、体腔の場所および病変部位の位置に拘わらずに、
内視鏡の視界を殆ど妨げることなく、病変部位に対し
て、その治療に適切な方向から処置具を容易に遠隔操作
して適切かつ正確な治療を施すことができる。
【図面の簡単な説明】
【図１】本発明の第１の実施の形態に係る内視鏡治療装
置を示す外観斜視図。
【図２】図１の内視鏡治療装置の遠位端付近をその側面
方向から見込んで示す外観斜視図。
【図３】図１の内視鏡治療装置の遠位端付近をその正面
方向から見込んで示す外観斜視図。
【図４】図１の内視鏡治療装置の近位端付近を示す外観
斜視図。
【図５】図１の内視鏡治療装置が備える内視鏡操作部お
よび処置具誘導挿入具操作部を内視鏡治療装置操作部用
架台に取り付けて使用する場合を示す外観斜視図。
【図６】図１の内視鏡治療装置が備える処置具誘導挿入
具の第１湾曲部付近を示す縦断面図。
【図７】図６中Ｖ−Ｖ線に沿って示す断面図。
【図８】図６の処置具誘導挿入具の第２湾曲部付近を示
す縦断面図。
【図９】図８中Ｗ−Ｗ線に沿って示す断面図。
【図１０】図６の処置具誘導挿入具が備える処置具用チ
ャンネルチューブ体の処置具用チャンネルチューブ体湾
曲部を示す断面図。
【図１１】（ａ）は、図６の処置具誘導挿入具を湾曲さ
せていない状態を示す縦断面図。（ｂ）は、図６の処置
具誘導挿入具を湾曲させた状態を示す縦断面図。
【図１２】図１の内視鏡治療装置の遠位端付近を胃の中
に挿入して病変部位を治療する様子を示す一部断面図。
【図１３】図１２の病変部位を治療する様子を内視鏡の
観察光学装置で捉えた映像を示す正面図。
【図１４】図１の内視鏡治療装置が備える治療装置導入
チューブ体の遠位端面をその正面方向から見込んで示す
外観斜視図。
【図１５】本発明の第２の実施の形態に係る内視鏡治療
装置が備える治療装置導入チューブ体の遠位端面をその
正面方向から見込んで示す外観斜視図。
【図１６】本発明の第２の実施の形態に係る内視鏡治療
装置の遠位端付近をその側面方向から見込んで示す外観
斜視図。
【図１７】図１６の内視鏡治療装置の遠位端付近をその
正面方向から見込んで示す外観斜視図。
【図１８】本発明の第３の実施の形態に係る内視鏡治療
装置の遠位端付近をその側面方向から見込んで示す外観
斜視図。
【図１９】図１８の内視鏡治療装置の遠位端付近をその
正面方向から見込んで示す外観斜視図。
【図２０】図１８および図１９の内視鏡治療装置が備え
る内視鏡操作部および処置具誘導挿入具操作部を内視鏡
治療装置操作部用架台に取り付けて使用する場合を示す
外観斜視図。
【図２１】図１８および図１９の内視鏡治療装置が備え
る処置具誘導挿入具の第１湾曲部付近を示す縦断面図。
【図２２】図２１中Ｘ−Ｘ線に沿って示す断面図。
【図２３】図１８および図１９の処置具誘導挿入具の第
２湾曲部付近を示す縦断面図。
【図２４】図２３中Ｙ−Ｙ線に沿って示す断面図。
【図２５】図１８および図１９の処置具誘導挿入具の第
３湾曲部付近を示す縦断面図。
【図２６】図２５中Ｚ−Ｚ線に沿って示す断面図。
【図２７】図２５の第３湾曲部の湾曲する向きを幾つか
示す正面図。
【図２８】図２５の第３湾曲部の湾曲する向きを幾つか
示す側面図。
【図２９】本発明の第４の実施の形態に係る内視鏡治療
装置の遠位端付近をその側面方向から見込んで示す外観
斜視図。
【図３０】図２９の内視鏡治療装置の遠位端付近をその
正面方向から見込んで示す外観斜視図。
【符号の説明】
１…内視鏡治療装置 ２…内視鏡 ３…鉗子（処置具） ４…処置具誘導挿入具 ５…治療装置誘導チューブ体 ６…内視鏡用チャンネル（治療装置用管路） ７…処置具誘導挿入具用チャンネル（治療装置用管路） １１…内視鏡挿入部 ２４…処置具誘導挿入具挿入部 ２６…鉗子チャンネル（処置具用管路） ２８…処置具誘導挿入具湾曲部 ２８ａ…挿入具第１湾曲部（処置具誘導挿入具湾曲部） ２８ｂ…挿入具第２湾曲部（処置具誘導挿入具湾曲部） １０１…治療装置用管路 ２０１…処置具誘導挿入具 ２０２…挿入具第３湾曲部（処置具誘導挿入具湾曲部） ２０８…処置具誘導挿入具挿入部

Claims (3)

    【特許請求の範囲】
  1. 【請求項１】 可撓性を有する挿入部を備えた内視鏡
    と、 この内視鏡による観察下において使用する複数の処置具
    と、 これら複数の処置具のうち少なくとも２つを独立に挿通
    して体腔内に誘導する処置具用管路を備えるとともに、
    可撓性を有する挿入部を備えた２本の処置具誘導挿入具
    と、 前記内視鏡および前記２本の処置具誘導挿入具のそれぞ
    れの挿入部を体腔内に誘導するとともに、前記２本の処
    置具誘導挿入具のそれぞれの挿入部を前記内視鏡の挿入
    部に対して互いに所定の対称位置に配置する治療装置用
    管路を備える治療装置誘導チューブ体とを具備し、 前記２本の処置具誘導挿入具のそれぞれの挿入部の遠位
    端部には、前記２本の処置具誘導挿入具のそれぞれの近
    位端部から遠隔操作することにより、前記内視鏡の挿入
    部に対して互いに所定の対称な向きに湾曲させられる湾
    曲部が設けられていることを特徴とする内視鏡治療装
    置。
  2. 【請求項２】 前記２本の処置具誘導挿入具のそれぞれ
    の挿入部の遠位端部に、その長手方向に沿って、互いに
    対向する位置に前記湾曲部をそれぞれ複数ずつ設置する
    とともに、互いに対向する位置に設置された前記複数の
    湾曲部ごとに、それぞれ異なる所定の対称な向きに、前
    記内視鏡の挿入部に対して互いに湾曲することを特徴と
    する請求項１に記載の内視鏡治療装置。
  3. 【請求項３】 前記複数の湾曲部のうち、それぞれの最
    近位側に設置された前記湾曲部は、これらの最近位側に
    設置された湾曲部より遠位側の前記２本の処置具誘導挿
    入具のそれぞれの挿入部の長手方向が、ともに前記内視
    鏡の挿入部の長手方向に対して乖離および接近する方向
    に沿って、互いに対称な向きに湾曲することを特徴とす
    る請求項２に記載の内視鏡治療装置。
JP13582299A 1999-05-17 1999-05-17 内視鏡治療装置 Expired - Fee Related JP4503725B2 (ja)

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