JP2002282268A - Insertion sheath - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical sheath for inserting an endoscope allowed to be safely and easily inserted in an abdominal wall without a needle and a plug, and allowing a plurality of treatment instruments and endoscopes to be simultaneously operated in the pneumoperitoneum. SOLUTION: This medical sheath for inserting an endoscope as medical treatment instrument has a conduit having a plurality of lumens, a valve member housing part connected to the conduit, a pneumoperitoneum gas filling inlet fitted to the valve member housing part, a plurality of contractile balloons fitted to the conduit and provided in the circumferential direction, and a converter allowing a fine treatment tool to air-tightly conduct. In this tube, at least a part of the distal end of the conduit is raised.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an insertion for inserting a plurality of treatment tools as well as an endoscope in an endoscopic surgery, which maintains airtightness even when inserted into a small incision. It relates to a mantle tube.

[0002]

2. Description of the Related Art In recent years, endoscopic surgery has been widely practiced. The operation under the endoscope is a method of performing an operation by remote control while watching an image viewed from the endoscope on a screen. There are two ways to insert a trocar into the patient's body when performing insufflation procedures. One is to use a pneumoperitoneal needle to inject carbon dioxide into the abdominal cavity and insert the required number of trocars sequentially with a trocar with a needle for insertion while the abdominal wall is raised in a tent shape, The other is to make a small incision in the umbilicus etc. in advance, insert a trocar with no needle or a blunt needle from there, send carbon dioxide through the gas inlet of the trocar, and make the abdominal wall into a tent shape In this method, a required number of trocars are sequentially inserted by a trocar with a needle for insertion. Recently, as a safer method, a method of making a small incision at a position where an organ is finally removed and inserting a first trocar is increasing.

The trocar used in this method is disclosed in
No. 187463, which generally has an obturator assembly for facilitating insertion into the small incision in addition to the mantle tube, and is inserted through the small incision while inserted into the mantle tube; After insertion, the obturator assembly is withdrawn. In these, the end surface of the mantle tube is circular, it is difficult to enter the small opening, and if the tip of the mantle tube is cut diagonally to make it easy to enter,
Since there is a risk of damaging organs in the body, an obturator assembly is required at the time of insertion, which increases the number of parts and increases costs.

A valve mechanism for maintaining the airtightness of the trocar is disclosed in Japanese Patent Laid-Open Publication No. Hei 1-209056. As a mechanism of a flap valve installed in a housing, a valve seat and a valve seat are connected. Mating valve plug, pressing means for pressing the valve plug, driving the valve plug and engaging with the valve seat,
A method of opening and closing by a detachable valve plug attaching means is shown. Although this method can surely maintain an airtight state, it has not only increased the number of parts but increased the cost, but also sometimes prevented the treatment tool from being properly inserted into the valve plug.

A mechanism for keeping the trocar and the abdominal wall airtight is disclosed in Japanese Utility Model Laid-Open No. 5-53651 or Japanese Patent Laid-Open No. 5-115429. Japanese Utility Model Laid-Open No. 5-53651 discloses a balloon catheter to be attached to a mantle tube, and a plurality of balloons sandwich the abdominal wall to prevent insufflation gas from leaking. However, since this specification is designed with an inner diameter that closely fits the mantle tube,
It was very difficult to attach / detach to / from the mantle tube. JP-A-5-11
No. 5429 discloses a trocar / sleeve assembly in which a part of the end is provided with a means for expanding the external dimension to a greater extent. If it can be fixed to the abdominal wall and if the expansion means is provided with an elastic coating or the like, airtightness equivalent to that of a balloon can be ensured, but the structure becomes complicated, and there is a problem that the number of processing steps is increased.

Further, a mechanism having a plurality of lumens is disclosed in
No. 327617, Japanese Patent Application Laid-Open No. 7-265321 or Japanese Patent Application Laid-Open No. 10-502841. Japanese Patent Application Laid-Open No. 6-327617 is characterized in that a channel is provided in an outer tube of a trocar having an outer tube and an inner needle that can be inserted into and removed from the outer tube. The purpose of this is to enable rapid hemostasis using a bioadhesive through the channel if bleeding occurs during endoscopic surgery. To the last, since the application of the bioadhesive is assumed, the structure in which the treatment tool can be inserted into the sublumen has not been considered.

Japanese Patent Application Laid-Open No. Hei 7-265321 discloses an inserter configured to insert and fix a position of at least two surgical tools such as a surgical tool, an optical tool, and an implant tool. This device is mainly intended for thoracoscopic treatment that does not require insufflation operation to secure the field of view, and multiple treatment tools can be inserted. No consideration has been given to a valve member or the like for preventing falling of the gas, and it cannot be used under pneumoperitoneum.

Furthermore, Japanese Patent Publication No. 10-502841 discloses a multi-port trocar having a plurality of working channels and a plurality of valves. This device is provided with a plurality of channels having a plurality of valves in the housing, so that treatment tools with different outer diameters can be inserted separately under pneumoperitoneum. It is also possible to do. However, it is assumed that the working channel and the valve attached thereto are formed separately from each other only at the entrance portion of the port, and the treatment instrument passes through the separate channels and valve members, and then together in the housing and the conduit. To become
For example, when the laparoscope and the treatment tool are inserted, there is a risk that moving both tools may cause partial contact and damage, or a risk that the tool will not move due to the touch.

[0009]

SUMMARY OF THE INVENTION The present invention aims to improve the performance of a mantle tube used in conventional endoscopic surgery, and aims to safely and easily apply to abdominal wall without using a needle or obturator. The object of the present invention is to provide a medical endoscope insertion mantle tube which can be inserted, can operate a plurality of treatment tools and endoscopes simultaneously under pneumoperitoneum, and can cope with treatment tools having different outer diameters. And

[0010]

That is, the present invention provides:
(1) A tubular conduit having one or more lumens, a first valve on a proximal end corresponding to each lumen contained in a valve member built-in portion communicating with the conduit, and a first valve on a distal end side. An insertion mantle tube comprising a second valve, a plurality of balloons attached to the conduit, and a converter, wherein at least a part of a distal end portion of the conduit is raised,
(2) The sectional shape of the distal end portion of the conduit is egg-shaped.
(3) The insertion mantle tube according to (1) or (2), wherein the valve member built-in portion comprises a housing, a valve seat, a first cap, and a second cap. The valve is integrally formed with the flap and the valve seat mounting portion, the valve seat mounting portion is fitted to the valve seat airtightly mounted on the valve member built-in portion, and the flap is pushed up by the reinforcing spring mounted on the valve seat (1). ) To (3), the insertion mantle tube according to any one of (1) to (4), and (5) a structure in which the balloon on the hand side of the plurality of balloons is slidable forward and backward in an airtight manner. (6) The insertion mantle tube according to any one of (1) to (5), wherein the converter comprises a converter body and a third valve.

[0011]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be specifically described below with reference to the drawings. FIG. 1 is an external view of an insertion mantle tube according to an embodiment of the present invention. FIG. 2 is a sectional view of a valve member built-in portion of an insertion mantle tube according to an embodiment of the present invention. FIG. 3 is a sectional view of a converter of an insertion mantle tube according to an embodiment of the present invention. 4A and 4B show a valve seat of an insertion mantle tube according to an embodiment of the present invention, wherein FIG. 4A is a plan view and FIG. 4B is a side view. 5A and 5B show a second valve of the insertion mantle tube according to an embodiment of the present invention, wherein FIG. 5A is a plan view thereof, and FIG. 5B is a sectional view thereof.

FIG. 6A is a perspective view showing a distal end shape of a conduit of an insertion mantle tube according to an embodiment of the present invention, and FIG. 6B is a perspective view of an insertion mantle tube according to another embodiment of the present invention. FIG. 3C is a perspective view showing the distal end shape of the conduit, FIG. 4C is a schematic view showing a state in which the distal end portion of the conduit is inserted into the incision, FIGS. 4D and 4E are schematic views showing the distal end of a conventional trocar, (F) is a schematic diagram of a state where a conventional trocar is inserted into an incision.
FIG. 7A is a cross-sectional view of an outer balloon of an insertion mantle according to another embodiment of the present invention, and FIG. 7B is a schematic view showing a state where the outer balloon can slide on a conduit. . FIG. 8 shows a use state diagram.

The structure of the insertion mantle according to the present invention is shown in FIG.
, An inner balloon (2) airtightly attached to the conduit (1), an outer balloon (3), and an inner balloon inflation tube for sending an inflation fluid to each balloon. (4) an outer balloon inflation tube (5), a pilot balloon (6) attached to the balloon inflation tube for monitoring the inflation state of the balloon, a gas-liquid opening / closing device (7) for maintaining the balloon inflation state, and A valve member built-in portion (8) for storing a valve member, etc.,
It has an insufflation gas inlet (19) attached to the valve member built-in part (8) to supply insufflation gas, and a converter (20).
As shown in FIG. 2, the valve member built-in portion (8) includes a housing (9) serving as a case, a valve seat (10) for attaching the valve member, a first cap (11) for fixing the valve member, and a second cap ( 12), as a valve member, first valves (13) and (15),
The converter (20) comprises a second valve (14) (16), a reinforcing spring (17) for assisting the opening and closing operation of the valve member, and a connection tube (18) for connecting the conduit (1) and the valve seat (10). 3) comprises a converter body (21) and a third valve (22) as shown in FIG.

(Conduit) The conduit (1) is usually produced by injection molding. The outer diameter of the conduit (1) is preferably φ1 to φ100 mm. When the diameter is smaller than φ1 mm, there is no insertable treatment tool, and when the diameter is larger than φ100 mm, the invasion to the patient increases, and the usefulness is lost. Total length is 5
~ 30 cm is desirable. If it is shorter than 5 cm, it may be buried in the abdominal wall in obese patients.
This is because the operability of the treatment tool is deteriorated if the length is longer than cm.

As shown in FIGS. 6 (a) to 6 (c), the distal end is not horizontal and obliquely cut, and at least a part of the distal end is easily cut into an incision. The shape with the raised ridges (33) is good, especially in FIG.
In the case where the cross-sectional shape of the tip portion is an oval shape as in (b), it becomes easier to enter by inserting into the incision from the protruding portion as shown in FIG. 6 (c). Such a commonly used obturator assembly (34) becomes unnecessary. Further, it has a plurality of lumens from the tip to the end, and the inner diameter thereof is preferably φ0.4 to φ50 mm.

[0016] This is because if the diameter is smaller than 0.4 mm, there is no insertable treatment tool, and if the diameter is larger than 50 mm, it is difficult to maintain airtightness of insufflation gas. The combination of the plurality of lumens may be either the same diameter or a combination of a large diameter and a small diameter. Although it is possible to use some of the multiple lumens as lumens for balloon inflation, multiple grooves are provided to extend the balloon inflation tubes (4) (5) in the longitudinal direction of the conduit (1). You may. As the material used for the conduit (1), a material such as a vinyl chloride resin, a polycarbonate resin, an ABS resin, a polyacetal resin, a polyamide resin, a polypropylene resin, a polyethylene resin, or a metal such as stainless steel is used.

(Balloon) The balloon is attached as shown in FIG. 1, for example, and includes an inner balloon (2) inside the abdominal cavity and an outer balloon (3) outside the body. These balloons are generally produced by blow molding, injection molding, compression molding, dip molding and the like. Multiple balloons can be molded alone,
It is also possible to integrally mold it, and it is attached to the conduit (1) by bonding with a solvent or an adhesive, heat welding by high frequency or the like.

The inner balloon (2) and the outer balloon (3) are respectively arranged in series on the conduit (1). For example, in order to correspond to a person from a fat person to a thin person, FIG. A balloon made in a double tube shape of an inner balloon (35) and an outer balloon (36) as in
As shown in FIG. 7 (b), the structure may be such that it is slid on the conduit (1) to adjust the thickness of the abdominal wall to maintain airtightness. The shape of the balloon is usually spherical or donut-shaped. When the balloon is deflated, even if it can be deflated almost the same as the outer diameter of the conduit (1), the balloon is preformed so that it has a little bulk. It may be shrunk to a bent shape.

At the time of inflation, for example, as shown in FIG. 1, the gas or liquid injected from the gas-liquid opening / closing device (7) is supplied to the pilot balloon (6), the inner balloon inflation tube (4), and the outer balloon inflation tube (5). ) And into the balloon,
Inflate the balloon. The outer diameter of the balloon when inflated is φ10
Φ200 mm, the width in the axial direction is preferably 5 to 50 mm, and when sandwiching the abdominal wall, the balloon interval is 3 to 70 mm.
mm is desirable. The thickness of the balloon depends on the material used, but the less bulk is better, 0.01mm to 5m
About m is desirable also from the viewpoint of expansion characteristics. The material of the balloon is natural rubber, silicone rubber, soft vinyl chloride resin,
A flexible material such as a polyurethane resin or a polyethylene terephthalate resin is desirable.

Next, the structure of the valve member built-in portion (8) will be described with reference to FIG. (Housing) The housing (9) is formed as shown in FIG. 1, and is usually manufactured by injection molding. Valve seat (1
0), attach (1) conduit (1) at the bottom and insufflation gas inlet (19) on the side. The mounting method may be any method that can maintain airtightness such as adhesion by a solvent or an adhesive, welding by ultrasonic waves or high frequency waves. Materials used for the housing (9) are vinyl chloride resin, polycarbonate resin, ABS resin,
Materials such as polyacetal resin, polyamide resin, polypropylene resin, polyethylene resin, and metals such as stainless steel are used.

(Valve Seat) The valve seat (10) is usually manufactured by injection molding. The valve seat (10) has a plurality of lumens. For example, as shown in FIG. 4, if the valve seat (10) has two lumens having different sizes, the first valve (large) mounting portion (23) Each of the second valve (large) mounting portion (24), the first valve (small), and the second valve (small) insertion portion (26) has a first valve (13).
(15) second valves (14) and (16) are attached,
Further, in order to hold down the first valves (13) (15), the first cap (11) and the second cap (12)
Are attached to the valve seat (10) and the second cap attaching portion (28) by fitting, bonding, welding, or the like.

When the second valve (14) is a flap valve having a shape as shown in FIG. 5, the second valve (large) mounting portion (2)
Attachment part (29) of the flap valve is attached to 4), and reinforcement spring (17) is attached to the reinforcement spring attachment part (25).
And a reinforcing spring fitting portion (3) of the second valve (14).
2) A reinforcing spring (17) is fitted into it. FIG. 2 illustrates a case in which a lumen for accommodating a treatment instrument having a large outer diameter such as a laparoscope and a lumen for accommodating a thin treatment instrument such as a snare are shown.

Each of the lumens of the valve seat (10) and each of the lumens of the conduit (1) are joined so that they can be inserted linearly when a plurality of rigid treatment tools are inserted. When the processing tool of (1) is used, the lumen of the valve seat (10) is inclined obliquely as shown in FIG. 2, and the connection tube (18) is connected to the connection tube mounting portion (27) of the valve seat (10). A route may be formed, or the shape of the valve seat (10) and the housing (9) may be devised so that the treatment tool advances into the lumen of the tube. The material used for the valve seat (10) is a metal such as vinyl chloride resin, polycarbonate resin, ABS resin, polyacetal resin, polyamide resin, polypropylene resin, polyethylene resin, or stainless steel.

(First Cap) First cap (1)
1) is formed as shown in FIG. 2 and the first valve (large) (13)
Is hermetically sandwiched between the first valve (large) mounting portion (23) of the valve seat (10). Usually, it is produced by injection molding. As a material used for the first cap (11), a metal such as a vinyl chloride resin, a polycarbonate resin, an ABS resin, a polyacetal resin, a polyamide resin, a polypropylene resin, a polyethylene resin, or a stainless steel is used.

(Second Cap) The second cap (1
2) is formed as in FIG. 2 and the first valve (small) (15)
And the second valve (small) (16) into the first valve (small) second valve (small) insertion portion (26) of the valve seat (10), and then the second cap (12). Is attached to the second cap attaching portion (28). Usually, it is produced by injection molding. As a material used for the second cap, a metal such as a vinyl chloride resin, a polycarbonate resin, an ABS resin, a polyacetal resin, a polyamide resin, a polypropylene resin, a polyethylene resin, or a stainless steel is used.

(First Valve) First Valve (13) (15)
The device functions to prevent the insufflation gas in the abdominal cavity from leaking out of the body through the conduit (1) and the valve member built-in portion (8) when the treatment tool is inserted. Usually, it is produced by injection molding or compression molding. The inner diameter of the first valve (13) (15) is φ0.3 to φ4
About 5 mm is good, and not only a circle but also a slit may be formed. The thickness is suitably about 0.1 to 10 mm. This is because if it is less than 0.1 mm, it may not be able to withstand the pressure of insufflation gas and may leak, and if it is more than 10 mm, the frictional resistance at the time of inserting the treatment tool becomes large, making insertion difficult. The material of the first valves (13) and (14) is not particularly limited as long as it has flexibility, and examples thereof include natural rubber, silicone rubber, isoprene rubber, vinyl chloride resin, polyurethane resin, and SEBS resin. Materials are used.

(Second Valve) The second valves (14) and (16) release insufflation gas in the abdominal cavity with the treatment tool removed. It functions to prevent leakage from the body through the conduit (1) and the valve member built-in portion (8). Usually, it is produced by injection molding or compression molding. The shapes of the second valves (14) and (16) are not limited, and may be any of flap type valves as shown in FIGS. In the case of a flap-type valve as shown in FIG. 5, some rigid molded products are normally provided with an opening / closing behavior by combining a spring member. However, the flap-type valve of FIG. Is characterized in that it is integrally formed with a flap portion that is closed, bent, and used in combination with a reinforcing spring (17) as a spring member.

As the material used for the second valves (14) and (16), natural rubber, silicone rubber, isoprene rubber, vinyl chloride resin, polyurethane resin, SEBS resin, polyethylene resin, polypropylene resin and the like can be used. The reinforcing spring (17) may be formed in a coil shape or a rod shape in addition to the plate shape as shown in FIG. 2, but it is appropriate to make the flap surface into a plate shape in which an effective force is applied. Reinforcement spring (1
As the material used in 7), a hard resin such as a vinyl chloride resin, a polycarbonate resin, an ABS resin, a polyacetal resin, and a polyamide resin, and a metal such as stainless steel can be used.

(Insufflation gas inlet) Insufflation gas inlet (1
9) is attached to the side surface of the housing (9) of the valve member built-in portion (8), but may be attached to an extracorporeal part such as the conduit (1) as long as connection is possible. When mounting to the housing (9), the mounting position may be anywhere on the outer periphery of the housing. However, when two lumens are used side by side as shown in FIG. 1, it is preferable to arrange them along the straight line. In this case, a pipe for insufflation gas is connected to the tip of the insufflation gas inlet, but the insufflation gas inlet (1
When 9) is positioned at a right angle without being aligned on a straight line, the position of the treatment tool cannot be kept constant due to the weight of the pipe, or a force tends to be applied to the root of the insufflation gas inlet (19). This is because when it turns to the ventral side, it is more likely to break. The insufflation gas inlet may be any one-way valve, two-way cock, three-way cock, etc., and is not limited. The material used is, but not limited to, a polycarbonate resin, a vinyl chloride resin, a polypropylene resin, or the like.

(Converter) The converter (20) comprises a converter body (21) and a third valve (22). However, the converter (20) may be integrally formed of the same material as the third valve (22). Usually, it is produced by injection molding or compression molding. The converter body (21) may be attached to the housing (9) and the first cap (11) in a shape as shown in FIGS. 1 and 2, or a screwing mechanism or the like may be applied. At this time, the airtightness is maintained by the third valve (22) and the first cap (1).
Is kept between 1). The attachment of the third valve (22) to the converter body (21) may be any of fitting, adhesion, insert molding, etc., as long as airtightness is maintained. As a material used for the converter body (21), a metal such as a vinyl chloride resin, a polycarbonate resin, an ABS resin, a polyacetal resin, a polyamide resin, a polypropylene resin, a polyethylene resin, or a stainless steel is used. The material used for the third valve is natural rubber, silicone rubber, isoprene rubber, vinyl chloride resin, polyurethane resin, SE
BS resin, polyethylene resin, polypropylene resin and the like can be used.

(Usage Method) Next, the actual use method of the insertion mantle tube according to the present invention will be described with reference to FIGS.
The effects of the present invention will be clarified. First, a small incision is made with a scalpel near the umbilicus of the patient. The insertion mantle according to the present invention is inserted from the small incision site. At this time, as shown in FIG. 6 (c), by inserting from the raised portion (33) of the conduit (1), it can be easily inserted from the small incision site. Next, as shown in FIG. 7B, the inner balloon (2) is inflated, and then the outer balloon (3) is inflated while pulling the conduit (1) forward. This fixes the conduit (1).

Here, if a slidable balloon is used for the outer balloon (3) as shown in FIG. 7B, it is possible to cope with a thick or thin abdominal wall. Subsequently, as shown in FIG. 8, the endoscope (38) is inserted into the conduit (1), and insufflation gas is also supplied. As a result, the abdominal cavity is lifted up in a dome shape, and a visual field and an operation field are secured. Subsequently, a plurality of trocars (37) are inserted into appropriate places to insert the treatment tool (40). The treatment tool (40) is introduced through these trocars (37) to perform necessary treatment. In addition, since various treatment tools (39) can be inserted through the route from the second cap, the trocar (3) can be compared with a normal treatment.
7) or the size of other trocars (37) can be reduced to a smaller size,
The number and size of injuries to the patient, and thus the prognosis of the patient, are better. At the time of removal, the inner balloon (2) on the distal end side can be easily removed by deflating it.

[0033]

According to the present invention, not only can a plurality of treatment tools and endoscopes be inserted at the same time, but also the number of trocars used for the patient is reduced, so that the number of wounds on the patient is reduced.
The size of other trocars can also be reduced to a smaller size, resulting in smaller scars and, consequently, early rehabilitation of patients,
It can be expected to reduce the healthcare economy. Further, as compared with a cuff for mounting, the labor for mounting the cuff can be saved, and a reliable airtightness can be maintained, which can contribute to a reduction in operation time.

[Brief description of the drawings]

FIG. 1 is an external view of an insertion mantle tube according to an embodiment of the present invention.

FIG. 2 is a cross-sectional view of a valve member built-in portion of the insertion mantle tube according to one embodiment of the present invention.

FIG. 3 is a cross-sectional view of a converter of an insertion mantle tube according to an embodiment of the present invention.

4A is a plan view of a valve seat of an insertion mantle tube according to an embodiment of the present invention, and FIG. 4B is a side view thereof.

5A is a plan view of a second valve of the insertion mantle according to one embodiment of the present invention, and FIG. 5B is a cross-sectional view thereof.

6 (a) is a perspective view showing a distal end shape of a conduit of an insertion mantle tube according to an embodiment of the present invention, and FIG. 6 (b) is a perspective view of a conduit of an insertion mantle tube according to another embodiment of the present invention. A perspective view showing a tip shape, (c) is a schematic view showing a state where a distal end portion of a conduit is inserted into an incision, (d) and (e) are schematic views showing a tip portion of a conventional trocar, and (f). FIG. 1 is a schematic view showing a state where a conventional trocar is inserted into an incision.

FIG. 7A is a sectional view of a slidable balloon of an insertion tube according to an embodiment of the present invention, and FIG. 7B is a schematic view.

FIG. 8 is a view showing a use state when an insertion mantle tube according to an embodiment of the present invention is inserted into an abdominal wall.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Conduit 2 Inner balloon 3 Outer balloon 4 Inner balloon inflation tube 5 Outer balloon inflation tube 6 Pilot balloon 7 Gas-liquid opening and closing device 8 Valve member built-in part 9 Housing 10 Valve seat 11 First cap 12 Second cap 13 One valve (large) 14 Second valve (large) 15 First valve (small) 16 Second valve (small) 17 Reinforcement spring 18 Connection tube 19 Insufflation gas inlet 20 Converter 21 Converter body 22 Third No. 23 First valve (large) attachment part 24 Second valve (large) attachment part 25 Reinforcement spring attachment part 26 First valve (small) second valve (small) insertion part 27 Connection tube attachment part 28 Second cap attaching portion 29 Valve seat attaching portion 30 Flap 31 Hook 32 Reinforcement spring fitting portion 33 Raised portion 34 Obturator assembly 35 Inner ball screw 36 outer balloon 37 trocar 38 endoscope 39 the treatment instrument 40 treatment instrument

Claims (6)

[Claims] 1. A tubular conduit having one or more lumens,
A first valve on the proximal side and a second valve on the distal side corresponding to each lumen contained in the valve member built-in portion communicating with the conduit,
What is claimed is: 1. An insertion mantle tube comprising a plurality of balloons and a converter attached to a conduit, wherein at least a part of a distal end portion of the conduit is raised. 2. The insertion mantle according to claim 1, wherein the cross-sectional shape of the distal end portion of the conduit is oval. 3. The insertion tube according to claim 1, wherein the valve member built-in portion comprises a housing, a valve seat, a first cap, and a second cap. 4. A second valve, wherein a flap and a valve seat mounting portion are integrally formed, a valve seat mounting portion is fitted to a valve seat hermetically mounted on a valve member built-in portion, and a flap is provided by a reinforcing spring mounted on the valve seat. The insertion mantle tube according to any one of claims 1 to 3, which has a structure for pushing up. 5. The outer tube for insertion according to claim 1, wherein the balloon on the hand side of the plurality of balloons has a structure that can be slid air-tightly back and forth. 6. The insertion tube according to claim 1, wherein the converter comprises a converter body and a third valve.