JP2003210399A - Endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope which can freely change the projecting position of a therapeutic instrument under endoscopic observation, facilitates positioning to an objective lesion region and permits exact and more efficient treatment. <P>SOLUTION: The endoscope is provided with a rotationally moving operating mechanism 20 which is disposed along an insertion portion 2 and is capable of operating a therapeutic instrument guide channel 14 for guiding a snare 25 into a lumen so as to rotationally move the channel around an axis with respect to an axial central direction of the insertion portion 2. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscope provided with a channel for inserting a treatment tool.

[0002]

2. Description of the Related Art In recent years, with the expansion of indications for treatment using endoscopes, there is an increasing demand for enhancing the function of endoscopes in treatment.

For example, the channel size of the treatment instrument insertion channel formed in the insertion portion of the endoscope for inserting the treatment instrument is increased, the number of channels is increased, and positioning for guiding the treatment instrument to the target lesion site is performed. It is easy.

Here, regarding the increase in the number of channels, a treatment endoscope having two channels or a normal endoscope having one channel in the insertion portion of the endoscope has a channel outside the insertion portion. The so-called external channel system, which is used to attach the device, has already been developed.

Further, Japanese Patent Laid-Open No. 11-192203 discloses an external channel type endoscope developed for the purpose of efficiently collecting a plurality of polyps.

[0006]

By the way, in performing more accurate and efficient treatment for excision of a broader lesion area, the treatment tool is guided to a position where the lesion area can be easily treated. It is important to ensure the proper positional relationship of the treatment tool with respect to the site.

Further, due to the complexity of the anatomical structure of the stomach, in the treatment in the stomach, it is very difficult to guide the treatment instrument to a position where the lesion site is easy to treat even though the lesion site is small. There are some cases. Therefore, the positioning of the treatment tool on the lesion site is very important.

However, in the above-described conventional endoscope, since the distal end portion of the treatment instrument insertion channel formed in the insertion portion of the endoscope is fixed to the distal end configuration portion of the endoscope, the treatment instrument insertion channel is not The protruding direction of the treatment instrument that protrudes from the tip opening portion to the front of the endoscope is substantially fixed in a specific direction depending on the position of the tip opening portion of the treatment instrument insertion channel.
Therefore, when changing the projecting direction of the treatment instrument projected from the distal end opening portion of the treatment instrument insertion channel, the bending portion of the endoscope is operated to be bent, or the distal end opening portion of the treatment instrument insertion channel is arranged. Since the range for operating the treatment instrument raising base is limited and the range for moving the treatment instrument is limited, there is a problem that the change range for changing the protruding direction of the treatment instrument is relatively narrow. As a result, as described above, in order to meet the demand for securing the proper positional relationship of the treatment tool with respect to the lesion site, at present, the situation is unavoidable depending on the skill of the operator who uses the endoscope. However, there is a problem that the operation of the endoscope when guiding the treatment tool to an appropriate position with respect to the lesion site becomes complicated, making it difficult for a beginner to operate, and taking time.

The present invention has been made in view of the above circumstances, and an object thereof is to make it possible to freely change the projecting position of a treatment tool under endoscopic observation and to facilitate positioning to a target lesion site. The objective is to provide an endoscope that enables more accurate and efficient treatment.

[0010]

According to a first aspect of the present invention, an endoscope having at least an observation window and an illumination window at a distal end portion of an insertion portion to be inserted into a lumen is provided along the insertion portion. In addition, the operation instrument guide channel for guiding the treatment instrument into the lumen is provided with a rotation operation means capable of rotating the treatment instrument guide channel in a direction around the axis of the insertion portion. It's a mirror.

According to the first aspect of the present invention, the treatment tool guiding channel is pivoted in the axial direction with respect to the axial direction of the insertion portion by the pivoting operation means so that the treatment instrument guiding channel is projected from the treatment tool guiding channel. The protruding position of the treatment instrument is freely changed.

According to a second aspect of the present invention, at least the observation window and the illumination window are provided at the tip of the insertion portion inserted into the lumen,
An endoscope provided with a treatment instrument guide channel that is disposed along the insertion portion and guides the treatment instrument into the lumen, wherein the treatment instrument guide channel is axial with respect to the axial direction of the insertion portion. The endoscope is characterized in that it is provided with a turning operation means capable of turning in a rotating direction.

According to the second aspect of the present invention, when the endoscope having the treatment instrument guide channel is operated, the treatment instrument guide channel is rotated in the axial direction with respect to the axial direction of the insertion portion by the rotating operation means. By the dynamic operation, the projecting position of the treatment tool projected from the treatment tool guiding channel can be freely changed.

[0014]

BEST MODE FOR CARRYING OUT THE INVENTION A first embodiment of the present invention will be described below with reference to FIGS. 1 to 6 (A) to 6 (E). FIG. 1 shows an endoscope 1 according to this embodiment. The main body of the endoscope 1 has an elongated insertion portion 2 that is inserted into a lumen.
The operation portion 3 on the hand side is connected to the base end portion of the. One end of a universal cord section 4 is connected to the operation section 3. A connector (not shown) is connected to the other end of the universal cord portion 4. The connector is detachably connected to a light source and an image processing device (not shown).

In addition, a proximal end portion of the bending portion 6 is connected to the distal end side of the elongated flexible tube portion 7 of the insertion portion 2. The tip end side of the curved portion 6 is connected to the base end portion of the tip end portion 5. As a result, the insertion portion 2 that is flexible and long as a whole is configured.

Further, at the tip portion 5, an observation cover lens 8 forming one end of the observation optical system, a nozzle 9 for cleaning the surface of the observation cover lens 8 and two illumination cover lenses 10 are provided. It is arranged.

Further, the operation section 3 is provided with two bending operation knobs 11 for remotely operating the bending section 6. The bending portion 6 is bent in the up-down direction by one bending operation knob 11, and the bending portion 6 is bent in the left-right direction by the other bending operation knob 11. Further, the operation section 3 is provided with an air / water supply operation button 12, a suction operation button 13 and the like, and a treatment instrument insertion port 15 is provided so as to project on the side of the connection with the base end of the insertion section 2. There is.

An external treatment instrument guide channel 1 for inserting a treatment instrument is provided on the outer peripheral surface of the insertion portion 2 of the endoscope 1.
4 are provided. The channel 14 extends along the insertion portion 2 of the endoscope 1. Here, the distal end side of the channel 14 is extended to the distal end portion 5 side of the endoscope 1, and the proximal side is extended to the operation portion 3. In addition, channel 1
The middle portion of 4 is bound to the flexible tube portion 7 of the endoscope 1 by a plurality of binding bands 16 and is provided side by side while maintaining flexibility.

The proximal side of the channel 14 is attached so as to communicate with the treatment instrument insertion port 15 provided in the operation section 3. Then, a treatment instrument such as the snare 25 shown in FIG. 5 is inserted into the channel 14 from the treatment instrument insertion port 15.

Further, as shown in FIG.
A holding ring 17 is fixed to the tip of the. The holding ring 17 is attached to the outer peripheral surface of the distal end portion 5 of the endoscope 1 so as to be rotatable in the circumferential direction. Therefore, channel 14
The distal end of is supported by the outer peripheral surface of the distal end portion 5 of the endoscope 1 via a holding ring 17 so as to be rotatable in the circumferential direction.

A cam groove 18 is provided on the inner peripheral surface of the holding ring 17. This cam groove 18 is the holding ring 1.
It is formed by an inclined groove that is inclined with respect to the circumferential direction of 7. Further, as shown in FIG. 3, two O-rings 19 are embedded outside the cam groove 18 on the inner peripheral surface of the holding ring 17. These O-rings 19 seal between the inner peripheral surface of the retaining ring 17 and the outer peripheral surface of the distal end portion 5 of the endoscope 1 to ensure water tightness between the outside and the inside of the endoscope 1.

Further, as shown in FIG. 3, the endoscope 1 is provided with a rotation operation mechanism (rotation operation means) 20 for rotationally driving the channel 14 with respect to the distal end portion 5 of the endoscope 1. There is.
The rotating operation mechanism 20 is provided with an operation wire 21 arranged inside the endoscope 1. A slider 21a is provided on the distal end side of the operation wire 21 and can be moved back and forth by pulling the operation wire 21.

Further, a guide groove 5a for guiding the movement of the slider 21a is formed in the distal end portion 5 of the endoscope 1 along the pulling direction of the operation wire 21. The base end of the first pin 21b is fixed to the slider 21a. The first pin 21b is provided so as to project outward. The tip end of the first pin 21b is inserted into the cam groove 18 of the holding ring 17 and is engaged therewith.
As a result, when pulling the operation wire 21, the first pin 21b moves in the pulling direction of the operation wire 21 together with the slider 21a. At this time, the first pin 21b slides along the cam groove 18 of the holding ring 17,
The forward / backward movement of the first pin 21b is converted into the rotational movement of the holding ring 17, and the holding ring 17 rotates in the axial direction with respect to the distal end portion 5 of the endoscope 1 in association with the forward / backward movement of the first pin 21b. The cam mechanism is configured.

A rotary operation knob 23 for operating the rotary operation mechanism 20 of the treatment instrument channel 14 is provided at the connecting portion of the operation portion 3 on the proximal side with the proximal end portion of the insertion portion 2. The rotary operation knob 23 is provided with respect to the main body of the operation section 3 and the insertion section 2
It is provided so as to be rotatable about the axis with respect to the axis direction of.

Further, an operation cam groove 24 is formed on the inner peripheral surface of the rotary operation knob 23 as shown in FIG. The operation cam groove 24 is formed by an inclined groove inclined in an oblique direction with respect to the circumferential direction of the rotary operation knob 23. The operation cam groove 24 of the rotary operation knob 23 is engaged with the second pin 22 fixed to the proximal end of the operation wire 21. A slider (not shown) that moves along the pulling direction of the operation wire 21 is interposed between the proximal end of the operation wire 21 and the second pin 22, similarly to the slider 21a on the tip side of the operation wire 21. Has been done. Thus, if the rotation operation knob 23 is turned, the rotation operation knob 23
The second pin 22 slides along the operation cam groove 24, and the movement of the second pin 22 at this time pulls the operation wire 21 to convert the rotational motion into the linear motion. There is.

Next, the operation of the above configuration will be described.
When using the endoscope 1 of the present embodiment, the elongated insertion portion 2 is inserted into the body cavity. Then, the endoscope 1 is used to bring the distal end portion 5 of the insertion portion 2 close to the vicinity of the malignant tumor H (see FIGS. 6A to 6E).

Thereafter, when the malignant tumor H is treated, a treatment tool such as a snare 25 is inserted into the channel 14 from the treatment tool insertion port 15, and the treatment tool such as the snare 25 projects outward from the tip of the channel 14. To be done. At this time, as shown in FIG. 5, the snare 25 is rendered in the observation image P of the observation optical system by the observation cover lens 8 or can be observed in the observation image P.

When the position of the snare 25 inserted in the observation image P of the endoscope 1 is changed, the rotary operation knob 23 is used.
To rotate. At this time, if the rotation operation knob 23 is turned, the second pin 22 slides along the operation cam groove 24 of the rotation operation knob 23, and the operation wire 21 is pulled by the movement of the second pin 22 at this time. Rotation operation knob 23
Is converted into a linear motion of the operation wire 21.

Further, the pulling operation of the operation wire 21 at this time drives the rotary operation mechanism 20 of the treatment instrument channel 14. When the rotation operation mechanism 20 is driven, the first pin 21 on the tip side is passed through the operation wire 21.
b moves back and forth along the pulling direction of the operation wire 21. When the first pin 21b moves back and forth, the retaining ring 1
The first pin 21b slides along the cam groove 18 of No. 7. Accordingly, the forward / backward movement of the first pin 21b causes the holding ring 17 to move.
Is again converted into the rotational movement of the first pin 21b, and the holding ring 17 rotates in the axial direction with respect to the distal end portion 5 of the endoscope 1 in association with the forward / backward movement of the first pin 21b. This allows the retaining ring 17
At the same time, the distal end of the channel 14 is rotationally driven in the circumferential direction (axial rotation direction) with respect to the outer peripheral surface of the distal end portion 5 of the endoscope 1.
The snare 25 is moved to a position where it is easy to treat.

Here, an example of treatment using the endoscope 1 of the present embodiment will be introduced with reference to FIGS. 6 (A) to 6 (E). When a malignant tumor H is found during observation with the endoscope 1, physiological saline is injected under the malignant tumor H by the local injection needle 26 as shown in FIG. 6 (A). As a result, the submucosal layer and the proper muscle layer are separated.

After that, the endoscope 1 is used, and as shown in FIG.
As shown in, a ring member 27 made of a heat conductive material is arranged on the outer peripheral portion of the malignant tumor H. Then, FIG. 6 (C)
Clipping is performed using several clips 28 between the part of the malignant tumor H and the ring member 27 as shown in FIG.

In this state, as shown in FIG. 6 (D), the hooking device 29 is projected through the channel 14 of the endoscope 1 and the hook member 30 provided at the tip of the hooking device 29 is used to form the ring member. Lock 27.

Then, as shown in FIG. 6 (E), the ring member 27 is hooked on the hooking device 2 in the state where a high frequency current is applied.
The root portion of the malignant tumor H is tightly bound while being pulled into the sheath portion 31 of 9, and the malignant tumor H is excised.

When this treatment method is used, by using the ring member 27 which is larger than the conventional snare, lesions larger than the conventional snare can be excised collectively. Further, since the ring member 27 is locked to each clip 28 when the root portion of the malignant tumor H is bound, the ring member 27 does not slip on the surface of the living tissue.

A plurality of types of ring members 27 having different sizes may be prepared in advance, and the ring member 27 having an appropriate size may be selectively used according to the size of the lesion site such as the malignant tumor H. . Further, as a slip stopper for the ring member 27, a needle may be provided on the outer periphery of the ring member 27 or a biomedical adhesive may be applied in advance.

Therefore, the following effects can be obtained with the above-mentioned structure. That is, in the endoscope 1 of the present embodiment,
Since the rotation operation means 20 that can rotate the treatment instrument guide channel 14 in the axial direction with respect to the axial center direction of the insertion portion 2 is provided, the position of the treatment instrument guide channel 14 can be changed under observation with an endoscope. The work of changing to a desired location becomes easier than before. Therefore, it is possible to facilitate the positioning to the target lesion site, which is one of the important factors for endoscopic treatment, and to provide an environment that enables more accurate and efficient treatment.

7 to 12 show a second embodiment of the present invention. This embodiment is the endoscope 1 according to the first embodiment (see FIGS. 1 to 6A to 6E).
The configuration of is modified as follows. Since the basic configuration of the endoscope 1 in this embodiment is substantially the same as that in the first embodiment, the same parts as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted.

That is, a dedicated channel 32 for inserting a treatment tool is built in the insertion portion 2 of the endoscope 1 of the present embodiment. Further, the base end portion of the dedicated channel 32 is connected to the dedicated channel insertion port 37 arranged in the operation portion 3.

The tip side of the dedicated channel 32 is connected to the dedicated channel opening 33 formed in the tip portion 5 of the insertion portion 2 of the endoscope 1. Further, as shown in FIGS. 9A and 9B, a treatment instrument raising base accommodating portion 5b is formed in the vicinity of the dedicated channel opening 33 inside the distal end portion 5. The treatment tool raising base 3 is provided in the treatment tool raising base housing portion 5b.
4 are provided. This treatment tool raising base 34 has a pin 34
It is rotatably supported by the wall of the treatment instrument raising base accommodating portion 5b by a.

Further, FIG. 9A shows the treatment instrument raising base 34.
The raising wire 36 disposed in the insertion portion 2 as shown in FIG.
The front end side of is connected. The rear end portion of the raising wire 36 extends to the operation portion 3 side.

Further, in the operation section 3, a raising lever 35 for raising the treatment instrument raising base 34 coaxially with the bending operation knob 11.
Is provided. A raising wire pulling device (not shown) arranged in the operation portion 3 is connected to the raising lever 35. A rear end portion of the raising wire 36 is fixed to the raising wire pulling device. By the rotation of the raising lever 35, the raising wire 36 in the insertion portion 2 is pulled, and the treatment instrument raising base 34 is rotated about the pin 34a, whereby the treatment instrument is raised. Is able to.

An external treatment instrument guide channel 3 for inserting a treatment instrument is provided on the outer peripheral surface of the insertion portion 2 of the endoscope 1.
8 is detachably attached to the endoscope 1. Here, as shown in FIG. 8, a ring-shaped external channel mounting groove 5c is formed on the outer peripheral surface of the distal end portion 5 of the endoscope 1. A pair of left and right guide holes 5d are provided along the axial direction of the insertion portion 2 at the bottom of the external channel mounting groove 5c. The first pin 21b of the operation wire 21 is inserted into the guide holes 5d from the inside and is provided so as to project to the outside.

Further, a substantially C-shaped retaining ring 17B is attached to the tip of the external channel 38 as shown in FIG. The holding ring 17B is detachably engaged with the external channel mounting groove 5c of the distal end portion 5 of the endoscope 1.

Further, a cam groove 18 formed by an inclined groove similar to the cam groove 18 of the retaining ring 17 of the first embodiment on the inner peripheral surface of the retaining ring 17B, and the retaining ring 17B in the circumferential direction. An extended guide groove 40 is provided and a packing 41 for sealing is embedded. A guide display 39 is engraved on the outer peripheral surface of the holding ring 17B at a position corresponding to the guide groove 40.

When attaching the tip of the external channel 38 to the tip 5 of the endoscope 1, the holding ring 17B is used.
With the guide mark 39 on the outer periphery of the first pin 21b protruding to the side surface of the tip portion 5 aligned, the first pin 21b is guided into the guide groove 40 on the inner surface of the retaining ring 17B, and finally the cam groove is formed. The first pin 21b is locked to the pin 18.

At this time, the packing 41 on the inner peripheral surface of the holding ring 17B is pressed against the wall surface of the external channel mounting groove 5c in the distal end portion 5 of the endoscope 1 to ensure watertightness between the outside and the inside of the endoscope 1. Has been done. By adopting such a form, the work of attaching the tip of the external channel 38 to the tip 5 of the endoscope 1 can be facilitated.

In addition, an external treatment instrument guide channel 38
A channel insertion port 42 is connected to the base end of the.
The channel insertion port 42 has a C-shaped locking arm 43.
Is projected sideways. The C-shaped locking arm 43 allows the external treatment instrument guide channel 3 to be attached.
The channel insertion opening 42 at the base end of the endoscope 8 is detachably attached to the main body of the operation portion 3 of the endoscope 1.

Further, as in the first embodiment, the middle portion of the channel 38 is bound to the flexible tube portion 7 of the endoscope 1 by a plurality of binding bands 16 so that it is provided side by side while maintaining flexibility. There is.

Further, in the present embodiment, suction plugs 44 are detachably attached to the dedicated channel insertion openings 37 and 42. This suction plug 4
Dedicated channel insertion port 37 and channel insertion port 4
A switching lever 45 is provided which opens and closes a pipe line (not shown) connecting the two, and switches between channel suction and channel suction on one side. Then, by operating this switching lever 45, the suction plug 44
It is possible to open and close a conduit (not shown) that connects both channels inside to switch between suction of both channels and suction of one side.

Next, the operation of this embodiment having the above configuration will be described. In this embodiment, by rotating the rotary operation knob 23, the rotary motion of the rotary operation knob 23 is converted into the forward / backward motion by the cam mechanism as in the first embodiment, and the operation wire in the insertion portion 2 is moved. The forward / backward movement is transmitted to the first pin 21b of the distal end portion 5 via 21 (see FIG. 3). As a result, the first pin 21b moves back and forth along the guide hole 5d along the pulling direction of the operation wire 21. When the first pin 21b moves forward and backward, the first pin 21b slides along the cam groove 18 of the retaining ring 17B. This movement of the first pin 21b causes the holding ring 1 to move.
Converted to 7B rotational motion. And this first pin 2
The holding ring 17B is linked to the forward / backward movement of 1b and the endoscope 1
It rotates about the axis along the external channel mounting groove 5c of the tip portion 5. As a result, the distal end of the external channel 38 together with the retaining ring 17B becomes the distal end portion 5 of the endoscope 1.
Since the outer peripheral surface is rotationally driven in the circumferential direction (axial rotation direction), the treatment instrument inserted in the external channel 38 is moved to a position where treatment is easy.

Further, although the external channel 38 is attachable to and detachable from the endoscope 1, it is possible to select the attachment position in two directions, up and down, and expand the selection range of the approach to the lesion site.

Further, in this embodiment, the treatment instrument raising base 34 of the dedicated channel 32 is operated as necessary. When using this treatment instrument raising base 34, the dedicated channel insertion port 3
The treatment instrument 46 shown in FIG. 10 is inserted into the dedicated channel 32 from 7 and the treatment instrument 46 is projected from the tip end portion of the dedicated channel 32 to the outside. At this time, as shown in FIG. 10, the treatment tool 46 is depicted in the observation image P of the observation optical system by the observation cover lens 8 or can be observed in the observation image P.

In this state, the coaxial raising lever 35 is operated to pull the raising wire 36 in the insertion portion 2. As a result, the treatment tool raising base 34 is raised as indicated by the arrow in FIG. 9 (A). At this time, the rising direction of the treatment instrument 46 raised by the treatment instrument raising base 34 is within the observation image P of the observation optical system by the observation cover lens 8 of the endoscope 1 as shown by the arrow in FIG. To move down.

Using the endoscope 1 of this embodiment, the treatment tool 46 is inserted into the dedicated channel 32, and the treatment tool raising base 34 is inserted.
When is operated, the treatment tool 46 moves downward in the observation image P under endoscopic observation as shown in FIG. 10, so that it is possible to turn over the fold 47 of the large intestine, for example. It should be noted that the large intestine is anatomically prone to fold formation, but it is generally said that it is difficult to observe the back side of the fold 47. Therefore, by using the endoscope 1 of the present embodiment, it becomes easy to observe the back side of the folds 47, which is said to be difficult in the conventional technique.

In the present embodiment, as shown in FIG. 10, the treatment tool 46 is set to project from the lower left in the observation image P under the endoscopic observation. It may be set to the upper left or upper right.

Further, when the layout of the raising wire 36 in the insertion portion 2 is arranged in the central portion of the flexible tube portion 7, the movement of the wire 36, which is reciprocally advanced and retracted, is suppressed, and the influence on other internal components is suppressed. Can be minimized.

Here, an example of treatment using the endoscope 1 of the present embodiment will be introduced with reference to FIGS. 11 (A) to 11 (C). When a malignant tumor H is found during observation with the endoscope 1, physiological saline is injected under the malignant tumor H with a local injection needle 26 as shown in FIG. Separate the layers.

Subsequently, the grasping forceps 48 and the high frequency snare 49 shown in FIG. 11B are inserted into the two channels 32 and 38 of the endoscope 1 of the present embodiment, and the electrode ring of the high frequency snare 49 is inserted. The grasping forceps 48 is passed through the portion 50 in advance. In this state, as shown in FIG. 11 (B), the grasping forceps 48 grasps the region of the malignant tumor H with a margin by the grasping portion 51 of the four claws.

Then, in the above state, FIG.
As shown in FIG. 3, the high frequency snare 49 is used to bind while energizing and the malignant tumor H is excised.

When this treatment method is used, a margin is secured in advance for the malignant tumor H, so there is no risk of dividing the malignant tumor H. Further, when the high frequency snare 49 is tightly bound, the electrode ring portion 50 of the high frequency snare 49 is locked to the grasping portion 51 of the grasping forceps 48, so that the electrode ring portion 50 does not slip on the surface of the living tissue.

Further, the shape of the gripping portion 51 of the gripping forceps 48 is shown in the present embodiment as having a configuration in which four claws are arranged in a substantially square shape, but in addition to this, a different shape depending on the shape of the lesion site is used. You may use it.

Therefore, in this embodiment, the external treatment instrument guide channel 38 is rotated in the axial direction with respect to the axial direction of the insertion portion 2 by the rotary operation means 20 similar to that in the first embodiment. Since it is operable, the work of changing the position of the external treatment instrument guide channel 38 to a desired place under observation with an endoscope becomes easier than in the conventional case. Therefore, similarly to the first embodiment, the positioning of the target lesion site, which is one of the important factors for the endoscopic treatment, is facilitated, and a more accurate and efficient treatment environment is provided. be able to.

In the second embodiment, when the external channel 38 is not attached, the protective cover 52 made of a cylindrical elastic body is attached to the tip portion 5 of the endoscope 1 as shown in FIG. .

As a result, the exposed first pin 21b
Is protected and the watertightness with the inside of the endoscope 1 can be secured, so that it can be diverted as a one-channel endoscope which can be used routinely.

Further, FIGS. 13 to 15 show a third embodiment of the present invention. In this embodiment, the configuration of the endoscope 1 of the first embodiment (see FIGS. 1 to 6A to 6E) is modified as follows. Since the basic configuration of the endoscope 1 in this embodiment is substantially the same as that in the first embodiment, the same parts as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted.

That is, a dedicated channel 61 for inserting a treatment tool is built in the insertion portion 2 of the endoscope 1 of the present embodiment. Further, the base end portion of the dedicated channel 61 is connected to the dedicated channel insertion opening 62 arranged in the operation portion 3.

Further, as shown in FIG. 14, a laterally elongated channel guide port 63 having a substantially arc shape is formed at the distal end portion 5 of the endoscope 1. Further, a cylindrical channel holder 53 is attached to the tip 5 so as to be rotatable in the circumferential direction.

A channel connecting ring 54 to be inserted into the channel guide port 63 is provided at the tip of the channel holder 53. The distal end side of the dedicated channel 61 is connected to the channel connecting ring 54 in a state of being inserted.

A cam groove 18 similar to the cam groove 18 of the holding ring 17 of the first embodiment is formed on the inner peripheral surface of the channel holder portion 53. The first pin 21b on the distal end side of the operation wire 21 is engaged with the cam groove 18 in a state of being inserted.

Therefore, in this embodiment, as in the first embodiment, the rotation operation knob 23 of the operation portion 3 is rotated to move the channel holder portion 53 to the tip portion 5.
Can be rotated along the circumferential direction. As a result, the distal end side of the dedicated channel 61 can be moved along the channel guide ring 63 together with the channel connecting ring 54. As a result, also in the present embodiment, the work of changing the position of the dedicated channel 61 to a desired position under the observation of the endoscope becomes easier than in the conventional case, similarly to the first embodiment. Therefore, it is possible to facilitate the positioning to the target lesion site, which is one of the important factors for endoscopic treatment, and to provide an environment that enables more accurate and efficient treatment.

Furthermore, in this embodiment, since the dedicated channel 61 is not exposed on the outer surface of the endoscope 1, it is possible to reduce the diameter of the insertion portion 2 of the endoscope 1.

In the third embodiment, when the positioning of the lesion site can be estimated, the elasticity for fixing the position of the distal end side of the dedicated channel 61 to the distal end portion 5 at a specific set position as shown in FIG. A cylindrical tip cap 55 composed of a body may be detachably attached. The tip cap 55 is provided with a channel connecting ring 56 that is inserted into the channel guide port 63. The distal end 57 of the dedicated channel 61 is inserted into the channel connecting ring 56 and is connected to the channel connecting ring 56.

In this case, the distal end cap 55 is pivotally operated along the circumferential direction of the distal end portion 5 of the endoscope 1 so that the channel connecting ring 56 can be moved within the channel guide port 63. The position of the tip portion 57 of the dedicated channel 61 can be set in advance to a desired position according to the positioning of the lesion site.

Furthermore, the present invention is not limited to the above-mentioned embodiments, and it goes without saying that various modifications can be made without departing from the gist of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. Note (Supplementary Note 1) An endoscope having at least an observation window and an illumination window, wherein an endoscopic instrument guide channel that is rotatable with respect to the outer periphery of the distal end portion of the insertion portion is provided.

(Additional Item 2) In an endoscope having at least one or more treatment instrument guide channels, an observation window and an illumination window, a treatment instrument guide channel rotatable with respect to the outer periphery of the distal end of the insertion portion is provided. An endoscope characterized by.

(Additional Item 3) The endoscope according to Additional Item 2, wherein the treatment instrument guide channel which is rotatable with respect to the outer periphery of the distal end portion of the insertion portion is detachable from the endoscope main body.

(Additional Item 4) In the treatment instrument guide channel mounting portion of the endoscope body, when the treatment instrument guide channel is not used, a protective means made of an insulator is provided in the mounting portion. The endoscope according to 3.

(Prior Art of Additional Items 1 to 4) In recent years, along with the expansion of indications for treatment using an endoscope, mechanical requirements for the endoscope in the treatment have also increased.

That is, the channel size for inserting the treatment instrument is increased, the number of channels is increased, and the positioning of the target lesion is facilitated.

Regarding the increase in the number of channels, a so-called external channel system has been already developed, in which a channel is attached to the outside of a treatment endoscope having two channels or a normal endoscope having one channel. There is.

Further, in the external channel system, Japanese Patent Laid-Open No. 11-192203 and the like developed for the purpose of efficiently collecting a plurality of polyps are disclosed.

(Problems to be Solved by Additional Items 1 to 4)
However, in order to more accurately and efficiently treat a wider range of lesions, it is important to secure a proper positional relationship between the treatment tools and the lesions. Further, in the treatment in the stomach, it may be very difficult due to the complexity of the anatomical structure of the stomach even though the lesion is small, and positioning for the lesion was very important.

In order to deal with these problems, at present, it is inevitable to rely on the skill of the operator who uses the endoscope.
It was sometimes very difficult for a beginner to operate.

(Objects of Supplementary Items 1 to 4) An object of the present invention is to develop an endoscope capable of freely changing a protruding position of a treatment tool under observation of an endoscope, which is not possible with a conventional endoscope. By doing so, it is possible to facilitate positioning of the target lesion and to provide an environment that enables more accurate and efficient treatment.

(Effects of Supplementary Items 1 to 4) In these embodiments, it becomes possible to change the position of the treatment instrument insertion channel to a desired position under endoscopic observation, which is advantageous for endoscopic treatment. It is possible to facilitate positioning of the target lesion, which is one of the important factors, and to provide an environment that enables more accurate and efficient treatment.

[0086]

According to the invention of claim 1, the treatment instrument guide channel disposed along the insertion portion for guiding the treatment instrument into the lumen is provided in the axial direction with respect to the axial direction of the insertion portion. Since the turning operation means capable of turning operation is provided, it is possible to freely change the protruding position of the treatment tool under the observation of the endoscope.
Positioning to the target lesion site can be facilitated, and more accurate and efficient treatment can be achieved.

According to the second aspect of the present invention, when the endoscope provided with the treatment instrument guide channel is operated, the treatment instrument guide channel is rotated in the axial direction with respect to the axial direction of the insertion portion by the rotating operation means. By operating, the projecting position of the treatment instrument projected from the treatment instrument guide channel can be freely changed.

[Brief description of drawings]

FIG. 1 is a perspective view of an endoscope showing a first embodiment of the present invention.

FIG. 2 is a perspective view showing a distal end portion of an insertion portion of the endoscope according to the first embodiment.

FIG. 3 is a longitudinal cross-sectional view of a main part showing an internal configuration of a distal end portion of an insertion portion in the endoscope according to the first embodiment.

FIG. 4 is a perspective view showing a rotation operation knob of a rotation operation mechanism of a treatment tool channel in the endoscope according to the first embodiment.

FIG. 5 is an explanatory diagram for explaining a movement operation of a snare in an endoscopic image of the endoscope according to the first embodiment.

FIG. 6 shows an example of treatment in the endoscope according to the first embodiment, and (A) is a perspective view showing a state where physiological saline is injected under a malignant tumor with a local injection needle; B) is a perspective view showing a state in which a ring member is arranged on the outer periphery of a malignant tumor site, and (C) is a perspective view showing a state where clipping is performed using several clips between the malignant tumor site and the ring member. , (D) is a perspective view showing a state in which a ring member is locked using a hook portion, and (E) is a perspective view showing a state in which a malignant tumor is tightly bound and excised.

FIG. 7 is a perspective view of an endoscope showing a second embodiment of the present invention.

FIG. 8 is a perspective view showing a distal end portion of an insertion portion of the endoscope according to the second embodiment.

9A and 9B show a treatment instrument raising base mechanism in an endoscope according to a second embodiment, where FIG. 9A is a longitudinal sectional view of a main part showing a peripheral structure of the treatment instrument raising base, and FIG. FIG.

FIG. 10 is an explanatory diagram for explaining a movement operation of the treatment tool under the endoscope observation of the endoscope according to the second embodiment.

FIG. 11 shows an example of treatment in the endoscope of the second embodiment, (A) is a perspective view showing a state in which physiological saline is injected under a malignant tumor with a local injection needle; (B) is a perspective view showing a state in which the four nails of the grasping forceps grip the malignant tumor area with a margin, and (C) binds while energizing using a high-frequency snare to malignant tumor. FIG.

FIG. 12 is a perspective view showing a state in which a protective cover is attached to the distal end portion of the insertion portion of the endoscope according to the second embodiment.

FIG. 13 is a perspective view of an endoscope showing a third embodiment of the present invention.

FIG. 14 is a perspective view showing a distal end portion of an insertion portion in the endoscope of the third embodiment.

FIG. 15 is a perspective view of a main part showing a modified example of the endoscope of the third embodiment.

[Explanation of symbols]

2 Insert 3 operation part 14 Treatment instrument guide channel 17 retaining ring 20 Rotation operation mechanism (rotation operation means) 21 Operation wire 23 Rotation operation knob 25 Snare (treatment tool)

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor Hidenobu Kimura             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Tatsuya Furukawa             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Takatsugu Yamatani             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Masaaki Nakazawa             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Nobuyuki Matsuura             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Hisao Yabe             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. F-term (reference) 4C061 HH21 JJ06

Claims (2)

[Claims] 1. An endoscope having at least an observation window and an illumination window at a distal end portion of an insertion portion to be inserted into a lumen, the endoscope being disposed along the insertion portion and guiding a treatment tool into the lumen. An endoscope comprising rotation operation means capable of rotating the treatment instrument guide channel in a direction around the axis of the insertion portion. 2. A treatment which has at least an observation window and an illumination window at a distal end portion of an insertion portion to be inserted into a lumen and is arranged along the insertion portion to guide a treatment instrument into the lumen. An endoscope including an instrument guide channel, wherein the treatment instrument guide channel is provided with a rotation operation means capable of rotating the treatment instrument guide channel in an axial direction with respect to an axial direction of the insertion portion. mirror.