JP2003305001A - Endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope that facilitates medical treatment by optimizing the positional relationship between a channel opening and an observation port disposed on the end surface of an insertion tube, in a 2-channel endoscope equipped with an operating tool guiding table for each channel. <P>SOLUTION: In the endoscope 1 having two operating tool inserting channels 11 and 12 that pass through the inside of the insertion tube and have their openings at the end surface of the distal end 5 of the insertion tube, respective openings 28 and 42 of the operating tool inserting channels 11 and 12 are disposed at equal distances from the observation port 8 disposed on the end surface. <P>COPYRIGHT: (C)2004,JPO

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscope, and more particularly, to two treatment tools which are inserted into an insertion portion and open at the distal end surface of the distal end portion of the insertion portion. The present invention relates to an endoscope having an insertion channel. 2. Description of the Related Art In recent years, in a treatment using an endoscope, a high-frequency knife as a treatment tool has been inserted into a treatment tool insertion channel of the endoscope with a view to excision of a widened lesion. In addition, a technique has been performed in which the submucosa is excised while the high-frequency knife is swung right and left. As a means for more reliably performing this procedure, a technique utilizing an endoscope provided with two treatment instrument insertion channels in an insertion portion has been proposed.
JP-A-2001-212078, Japanese Utility Model Application Laid-Open No. 54-34
No. 281. The technique disclosed in Japanese Patent Application Laid-Open No. 2001-212078 discloses a technique in which a grasping forceps is inserted into one treatment instrument insertion channel, a mucous membrane is grasped by the grasping forceps, and a treatment instrument raising mechanism is used. The mucous membrane is lifted up, a high-frequency knife is inserted into the other treatment instrument insertion channel, and the exposed submucosal layer is peeled off while shaking the high-frequency knife by the treatment instrument raising mechanism. At this time, the treatment tools are arranged so that the directions of raising the treatment tools by the respective treatment tool raising mechanisms are orthogonal to each other. In Japanese Utility Model Laid-Open Publication No. 54-34281, openings of respective treatment tool insertion channels in a two-channel endoscope are arranged on the center line of the distal end face of the endoscope insertion portion. Is disclosed. In a conventional two-channel type endoscope provided with a treatment instrument raising base that moves in the vertical direction, a grasping forceps is inserted into one treatment instrument insertion channel to lift the lesion in the vertical direction, and the other end is lifted. The maximum merit of a two-channel endoscope with a treatment tool guide table in each channel, while only a uniform treatment using a high-frequency knife or high-frequency snare in the treatment tool insertion channel was possible. Is that a grasping forceps or a high-frequency knife can be selectively used in either of the two treatment tool insertion channels.
This is particularly effective for mucosal resection in anatomically complicated organs such as the stomach. [0006] However, Japanese Patent Laid-Open No.
The endoscope disclosed in JP-A No. 001-212078 includes
Although the movable direction of the treatment instrument raising table is clearly specified,
The effective positional relationship between the respective treatment tool insertion channels or the treatment tool guide tables is not taken into consideration. On the other hand, the positional relationship described in Japanese Utility Model Laid-Open Publication No. 54-34281 for disposing the treatment tool insertion channels on the center line of the distal end portion of the endoscope is different in a mucosal resection technique. Improper. An object of the present invention has been made in view of the above circumstances, and has a treatment tool guide table provided for each channel.
In a channel-type endoscope, taking into account the positional relationship between the channel opening disposed on the distal end surface of the insertion portion and the observation window, the optimal positional relationship between the two treatment tool insertion channels and the treatment tool guide table is also considered. An object of the present invention is to provide an endoscope which can easily perform treatment in consideration of the endoscope. [0009] In order to achieve the above-mentioned object, an endoscope according to the present invention comprises two treatments which are inserted into an insertion portion and open at the distal end surfaces of the distal end portion of the insertion portion. In an endoscope having a tool insertion channel, each opening of the treatment tool insertion channel is arranged at an equal distance from an observation window provided on the distal end surface. Embodiments of the present invention will be described below with reference to illustrated examples. FIG. 1 shows an entire configuration of an endoscope according to an embodiment of the present invention. As shown in FIG. 1, an endoscope 1 includes an insertion portion 2.
And an operating section 3 connected to the base end of the insertion section 2 and extending laterally from the operating section 3 to a light source device (not shown) or an image processing device (not shown) at the distal end. A universal cord 4 having a connector (not shown) detachably connected thereto. The insertion section 2 is configured as a soft and long body as a whole by sequentially connecting a tip section 5, a bending section 6, and a flexible tube section 7 from the tip side. An observation cover lens 8 constituting an observation window according to the present invention, which makes an observation light image incident on an observation optical system, and a nozzle 9 for cleaning the surface of the observation cover lens 8 are provided on the end surface of the end portion 5. A first treatment tool insertion channel 1 for inserting a treatment tool or the like is provided in the insertion section 2 in which two illumination cover lenses 10 and a channel opening described later are provided.
The first and second treatment tool insertion channels 12 are respectively inserted. The distal ends of the first treatment instrument insertion channel 11 and the second treatment instrument insertion channel 12 are:
Each base end portion extends to the distal end portion 5, and a first treatment instrument insertion port 1 provided in the operation portion 3 via the insertion portion 2.
3. The second treatment instrument insertion port 14 is in communication with each other. When the surgeon performs treatment, these treatment tool insertion ports 13,
Insert the treatment tool from 14. Further, the first treatment instrument insertion channel 11 and the second treatment instrument insertion channel 1
An upper and lower treatment tool guide table 15 and a left and right treatment tool guide table 16 are respectively disposed at the distal end of the second treatment tool. The operation section 3 includes a grip section 17 for the operator to hold the endoscope 1, a main operation section 18, and a sub-operation section 19. The main operation section 18 includes An up / down bending operation knob 20 for controlling the vertical bending operation of the bending section 6 and a left / right bending operation knob 21 for controlling the left / right bending operation are provided. An upper and lower guide base operation knob 22 for controlling the moving operation and a left and right guide base operation knob 23 for controlling the left and right treatment tool rocking operation of the guide base 16 are rotatably projected. Further, the main operation unit 18 is provided with an air / water supply operation button 24, a suction operation button 25, a remote switch button 26, and the like. On the other hand, the sub-operation unit 19 has a cleaning base 2 for cleaning the conduit through which each towing wire for operating each of the treatment tool guide tables 15 and 16 is inserted.
7 are provided. Next, with reference to FIGS. 2 and 3, the configuration of the treatment tool guide tables 15 and 16 will be described. Here, only one upper and lower treatment tool guide table 15 will be described, but the basic configuration is the same for the other left and right treatment tool guide table 16. FIG. 2 shows the overall configuration of the vertical treatment tool guide table unit 38, and FIG.
5 and the configuration in the vicinity thereof are shown in a cross-sectional view along the rotation shaft 29. The upper / lower treatment instrument guide table 15 communicates with the distal end of the first treatment instrument insertion channel 11 at the center thereof and forms a channel opening at the distal end surface of the insertion section 2.
A treatment instrument guide hole 28 is formed in the longitudinal direction of the insertion section 2, and a rotation shaft 29 is protruded at the center of the upper surface of the upper and lower treatment instrument guide 15, and a shaft hole 30 is formed at the center of the lower surface. Are formed. The rotating shaft 29 is engaged with a shaft hole 32 provided in the main body 31 of the distal end portion 5, and a fixing screw 33 is screwed into the screw hole 34 of the distal end body 31 in the axial hole 30. By engaging, the upper and lower treatment tool guide table 15
Is a rotating shaft 29 and a fixing screw 33 with respect to the tip end body 31.
Are disposed so as to be rotatable around the center. Further, a first wire insertion hole 35 is formed in the upper and lower treatment tool guide table 15 in a direction substantially orthogonal to the central axis direction of the first treatment tool guide hole 28.
5 at positions substantially parallel to the central axis direction of the first treatment instrument guide hole 28 and at a distance c from the center line of the first wire insertion hole 35. A wire insertion hole 36 is formed, and one vertical pulling wire 37 is inserted into the first wire insertion hole 35 and the second wire insertion hole 36. A vertical tow wire 37 extends. The extended vertical pulling wire 37 is
It is connected to the vertical guide base operation knob 22 via the inside of the insertion section 2, and the vertical operation wire guide 37 is pulled by the rotation operation of the vertical guide base operation knob 22, and the vertical treatment instrument guide base 15 is rotated. It has become. The upper and lower tow wires 37 are disposed at a position separated by the distance c as described above and orthogonally disposed at the first wire insertion hole 35 and the second wire insertion hole 3.
6 and is arranged in a U-turn shape by being folded back at the first wire insertion hole 35, so that the upper and lower treatment tool guide table 15 has an elastic force of the upper and lower traction wire 37 itself at its rotational position. Locked by. Therefore, the provision of the locking means allows the vertical treatment instrument guide table 15 and the vertical pulling wire 37
The assembling of the upper / lower treatment instrument guide table unit 38 constituted by the above does not require fixing means such as bonding, so that the operation is simplified and the assembling time can be shortened. Naturally, the replacement work of the upper and lower treatment tool guide table 15 in the repair is also simplified. In addition, since the connection structure between the upper and lower treatment tool guide table 15 and the upper and lower traction wire 37 is not complicated, the upper and lower treatment tool guide table unit 38 can be made compact. Conventionally, as shown in FIG. 4A, the inner diameter f of the first treatment tool guide hole 28 in the upper and lower treatment tool guide table 15 and the first channel opening 3 in the distal end main body 31.
The inner diameter g of No. 9 was formed to have substantially the same diameter. Usually, the sheath portion 41 of the treatment tool 40 has a strong waist in consideration of the insertability of the long treatment tool insertion channel, but the treatment tool is swung using the upper and lower treatment tool guide table 15. In such a case, there is a concern that a sufficient swing angle θ1 cannot be obtained due to the strength of the waist. Therefore, in the present embodiment, as shown in FIG. 4B, the first channel opening in the distal end body 31 with respect to the inner diameter f of the first treatment tool guide hole 28 in the upper and lower treatment tool guide table 15. The inner diameter of the portion 39 is formed as a wide inner diameter h, and the treatment instrument 4 is
Even when swinging 0, the sheath portion 41 of the treatment tool 40 can be sufficiently bent using the wide space in the first channel opening 39 so that a sufficient swing angle θ2 can be secured. Designed. The cross-sectional shape of the first channel opening 39 may be an elliptical shape whose minor axis is the same as the inner diameter f of the first treatment instrument guide hole 28. As shown in FIG. 5, the outer diameter D of the upper and lower guide operation knob 22 protruding from the sub-operation section 19 for operating the upper and lower treatment tool guide 15 and the left and right treatment tool guide 16 are controlled. The relationship between the outer diameter E of the left and right guide stand operation knobs 23 for operation and the outer diameter E is such that the diameters of the knobs near the sub-operation unit 19 are large, such as D> E. The operability of the operation knobs 22 and 23 is improved so as not to interfere with the operation. Next, the positional relationship between the upper and lower treatment tool guide tables 15 and the left and right treatment tool guide tables 16 according to the present invention and the effects thereof will be described with reference to FIGS. FIG.
FIG. 7 is an enlarged view of the distal end surface of the distal end portion 5, and FIG.
(A) and (B) show an endoscope image during treatment, and FIG. 8 shows a positional relationship between the treatment instrument guide holes 28 and 42 and the observation cover lens 8. On the distal end surface of the distal end portion 5, a distance a1 between the center of the observation cover lens 8 disposed substantially at the center and the center of the first treatment instrument guiding hole 28 of the upper and lower treatment instrument guiding table 15,
The relationship between the distance a2 between the center of the observation cover lens 8 and the center of the second treatment tool guide hole 42 of the left and right treatment tool guide table 16 is as follows.
a1 = a2. The greatest advantage of the two-channel endoscope in which the treatment tool guide tables 15 and 16 are provided in the respective treatment tool insertion channels 11 and 12 is that the grasping forceps 43 can be used in any of the two treatment tool insertion channels. And a treatment instrument such as a high-frequency knife 45 can be selectively inserted and used. For example, as shown in FIG. 7A, the grasping forceps 43 is inserted into the first treatment instrument insertion channel 11, and the lesioned part 44 grasped by using the upper and lower treatment instrument guide table 15 is lifted up. The high-frequency knife 45 is inserted through the two-treatment tool insertion channel 12, and the high-frequency knife 45 is swung right and left using the left and right treatment tool guide tables 16 to peel off the exposed submucosal layer, and FIG. 7 (B). As shown in FIG. 5, the grasping forceps 43 is inserted into the second treatment tool insertion channel 12, and the lesioned part 44 grasped using the left and right treatment tool guide table 16 is pulled up to the left side of the endoscope field of view. The high-frequency knife 45 is inserted into the insertion channel 11, and the upper and lower treatment tool guide table 1 is inserted.
5, it is possible to shake the high-frequency knife 45 up and down to peel off the exposed submucosal layer. As described above, the first treatment tool guide table 15
By making the distance between the treatment tool guide hole 28 and the second treatment tool guide hole 42 of the left and right treatment tool guide table 16 and the observation cover lens 8 substantially the same, the grasping forceps 43 is moved upward by the upper and lower treatment tool guide table 15. Even if lifted, the left and right treatment tool guide table 16
Therefore, if the swing angle of each guide table is set to be the same, the guide table can be lifted by the same amount of movement even if it is pulled to the left. Also in the high-frequency knife 45, even when the knife is swung right and left by the left and right treatment tool guide tables 16 and up and down by the upper and lower treatment tool guide tables 15, the cutting can be performed with the same swing width. That is, the first treatment instrument insertion channel 11 and the second treatment instrument insertion channel 1
Regardless of which of the two treatment tool insertion channels is used, the same operation feeling of each treatment tool can be obtained. This is particularly effective in treating and treating anatomically complicated organs such as the stomach. Next, referring to FIG. 8, the center of the optimal observation cover lens 8 and the first treatment tool guide hole 28 (second treatment tool) of the upper and lower treatment tool guide 15 (left and right treatment tool guide 16). The distance a1 (a2) from the center of the guide hole 42) will be described. When performing a treatment under endoscopic observation, it is desired that the treatment tool 40 protrudes within a quarter or less of the endoscopic visual field. When the amount of projection of the treatment tool 40 from the distal end portion 5 of the endoscope for performing a normal treatment is L, and the viewing angle in the direction orthogonal to the swinging direction of the treatment tool 40 is α, the above range is achieved. The following formula is established. A1 (a2) ≦ [L · t an (α / 2)] / 2 Note that the present invention is not limited to the treatment tool insertion channels 11 and 12, and as shown in FIG. In order to wash the water, the distance between the center of the observation cover lens 8 and the center of the front water supply port 46 in the left-right direction and the vertical direction is also set to b1 at the front water supply port 46 provided on the distal end surface of the insertion portion. , B2, the positional relationship is b1 =
As for b2, it is possible to provide an endoscope with excellent operability. Further, as shown in FIG. 9, the swing range of the upper and lower treatment tool guides 15 and the left and right treatment tool guides 16 in the amount of projection L of the treatment tool 40 from the distal end portion 5 of the endoscope for performing a normal treatment. If the swing range is set so as not to interfere with each other, the treatment tools do not come into contact with each other at the time of treatment, so that treatment can be performed more safely. Further, in the present invention, the upper and lower treatment tool guide tables 15 and the left and right treatment tool guide tables 16 are provided at the distal end portion 5, but as shown in FIG. If the distal end cover 47 made of the elastic body is used, the upper and lower treatment tool guide table 15 and the left and right treatment tool guide table 16 can be washed with the brush 48 in a state where the tip cover 47 is detached from the distal end body 31. The cleaning work can be performed easily. The distal end cover 47 is fixed to the distal end main body 31 by a convex portion 49 protruding from the inner surface of the elastic distal end cover 47 over the entire circumference and the outer circumference of the distal end body 31 over the entire circumference. This is performed by elastic engagement with the concave portion 50 provided. Next, a treatment method using the endoscope 1 of the present invention will be described with reference to FIGS.
FIGS. 11A and 11B show a state in which a transparent cap 51 is attached to the distal end portion 5 of the endoscope 1, and FIG. 12 shows a state in which treatment is performed using the transparent cap 51. As shown in FIGS. 11 (A) and 11 (B), several washing ports 53 opened in front of the transparent cap 51 are provided with a water supply tube 52 extending from the side. 5
In addition, the transparent cap 51 is provided with an inclined portion 55 having a smaller diameter as it moves to the front end of the transparent cap 51 in front of the washing port 53. When performing treatment, as shown in FIG.
This inclined portion 55 is sunk under the lesioned portion 44 which has been cut all around in advance, and the high-frequency knife 45 inserted from the second treatment tool insertion channel 12 is protruded. Shake left and right using 16 to peel off the exposed submucosal layer. At this time, since the transparent cap 51 is made of a transparent material, the visual field is clear, and the resection can be performed while confirming the submucosal layer, so that safer treatment is possible. Further, since there is no need to lift the mucous membrane using the grasping forceps 43 or the like, simple treatment is possible. When mucus or the like adheres to the inclined portion 55 of the transparent cap 51 and the visual field becomes unclear, the water supplied from the water supply tube 52 can be blown out from the cleaning port 53 to remove the attached matter. Further, the endoscope 1 of the present invention is
Is provided, the weight of the operation unit 3 is slightly increased. For this reason, an endoscope holder 56 that supports the operator in holding the endoscope is provided. FIG. 13 shows the structure of the endoscope holder 56. As shown in FIG. This endoscope holder 56 is
It is composed of a holder body 57 and a strap part 58. Further, the holder body 57 is formed with a holding portion 59 at one end, a grip holder 60 at a middle side edge, and an operation portion receiver 61 at the other end. When setting the endoscope 1, the holding section 59 is inserted into the end stop 1 of the endoscope 1, the grip holder 60 is inserted into the grip section 17 of the endoscope 1, and the operation section receiver 61 is inserted into the endoscope 1. It is locked to the main operation part 18 of the mirror 1 respectively. Then, the operator uses the endoscope holder 56 holding the endoscope 1 by hanging the strap portion 58 on the neck. According to this method, the endoscope 1 can be attached to the endoscope holder 56 in the horizontal direction, so that the operator's fatigue during the endoscope inspection can be reduced. This horizontal mounting is particularly effective in colonoscopy in which the operation unit 3 is held in the horizontal direction. Next, another example of use of the endoscope holder 56 will be described. FIG. 14 shows a state in which the treatment tool 40 is locked and held by the endoscope holder 56. The holder 5 of the endoscope holder 56
A locking portion 63 is protruded in the vicinity of 9, and the locking portion 63 is provided with a sheath locking groove 64 and an operation portion locking groove 65. Then, the treatment instrument 40 is attached to the endoscope holder 56 by engaging the coil sheath portion 66 of the treatment instrument 40 in the sheath engagement groove 64 and the operation section main body 67 of the treatment instrument 40 in the operation section engagement groove 65. Can be retained. Therefore, the surgeon can quickly take out the treatment tool 40 during treatment. As described above, in the embodiment of the present invention,
By making the distance between the first treatment tool guide hole 28 of the vertical treatment tool guide table 15 and the second treatment tool guide hole 42 of the left and right treatment tool guide table 16 and the observation cover lens 8 approximately the same, either treatment tool can be used. Even if the insertion channels 11 and 12 are used, the operation feeling of each treatment tool is the same, and it is possible to provide the endoscope 1 excellent in operability at the time of treatment. [Appendix] According to the embodiment of the present invention described in detail above, the following configuration can be obtained. 1. An endoscope having an elongated insertion portion, two treatment instrument insertion channels that are inserted through the insertion portion and open at the distal end surface of the insertion portion distal end portion, and an observation window, An endoscope in which the centers of the treatment tool guide holes in the respective treatment tool guide tables, which are the respective openings of the respective treatment tool insertion channels, are arranged at an equal distance. 2. Appendix 1 is characterized in that two treatment tool insertion channels are arranged in a vertical direction and a horizontal direction with respect to an endoscope visual field, respectively. 3. It has a slender insertion section, and a treatment tool guide table is arranged on the front surface of the distal opening of each of the two treatment tool insertion channels inserted through the insertion section, and has an observation window at the distal end of the endoscope. In the endoscope, each treatment tool insertion channel is arranged at an equal distance to the observation window. 4. Appendix 3 is characterized in that the treatment tool guide table is movable vertically and horizontally with respect to the endoscope visual field. 5. The supplementary note 1 to the supplementary note 4, characterized in that the front water supply conduit provided at the distal end portion of the insertion portion is arranged at an equal distance from each treatment instrument insertion channel. 6. A treatment tool insertion channel having an elongated insertion portion, wherein a treatment tool insertion channel inserted through the insertion portion is opened at the distal end portion of the insertion portion, and treatment tool guiding means and the treatment tool guiding means disposed on the front surface of the opening; In the endoscope having two traction means extending from the endoscope, the treatment tool guiding means is formed by a treatment tool guiding table having two grooves provided respectively on surfaces that are not in the same plane, and An endoscope comprising: a treatment tool guide table unit formed of one wire inserted into each of the grooves. 7. An endoscope having a slender insertion portion, wherein the treatment tool insertion channel inserted through the insertion portion is opened at the distal end of the insertion portion, and the treatment device guide means is disposed in front of the opening. An endoscope, wherein the inner diameter of a treatment tool insertion channel in the distal end portion of the endoscope is larger than the inner diameter of a treatment tool guide hole provided in a treatment tool guide table serving as the treatment tool guide means. 8. Appendix 7 is characterized in that a wall in the treatment tool insertion channel is provided on an axial extension of the inner diameter of the treatment tool guide hole when the treatment tool guide table is at the maximum inclination. 9. Appendix 7 and Appendix 8 are characterized in that the inner diameter of the treatment instrument insertion channel in the distal end portion of the endoscope is partially narrowed. 10. In the supplementary notes 7 to 9, the central axis of the treatment instrument guide hole in the treatment instrument guide table and the central axis of the treatment instrument insertion channel in the distal end portion of the endoscope are provided on substantially the same plane. 11. In Supplementary Notes 7 to 10, a part of the treatment tool insertion channel in the distal end portion of the endoscope is formed in an elliptical shape. As a swing mechanism for swinging the treatment tool, two towing wires are connected to both sides of the treatment tool guide member, and these wires are pulled into the treatment tool guide member by a pulling operation. Japanese Patent Application Laid-Open No. Hei 7-23895 discloses a technique for distributing inserted treatment tools. Regarding the size relationship between the channels of the treatment instrument insertion channel, the cross-sectional shape of the treatment instrument insertion channel pipe is set to be long in order to improve the penetrability of the treatment instrument in the treatment instrument insertion channel. A circular technology is disclosed in Japanese Utility Model Laid-Open No. 58-108802. However, in the structure disclosed in JP-A-7-23895, it is necessary to connect two tow wires to the treatment instrument guiding member.
Since these are performed by bonding or soldering, their mounting structures have to be complicated. In the structure in which the treatment tool is swung by using the treatment tool rocking table, means for effectively deriving the swing angle has not been proposed, and the treatment tool rocking table in the treatment tool rocking table has not been proposed. There is no one that considers the positional relationship between the inner diameter of the moving hole and the inner diameter of the channel opening inside the endoscope end. "Additional Means / Functions / Effects"
One vertical pulling wire is inserted into the first wire insertion hole provided on the treatment instrument guide table and the second wire insertion hole provided at a position distant from the first wire insertion hole, and the wire itself has an elasticity. Since the wire can be locked to the treatment tool guide table by force, a treatment tool guide table unit that has a simple configuration and is easy to assemble and repair can be provided. According to the present invention, the inner diameter of the channel opening in the endoscope main body is set to be wider than the inner diameter of the treatment instrument guide hole in the treatment instrument guide table, so that a large space in the channel opening is provided. Since the sheath portion of the treatment tool can be sufficiently bent by utilizing the same, the relationship between the diameter of the treatment tool guide hole and the diameter of the channel opening is improved, and an endoscope that can secure a sufficient swing angle is provided. can do. As described above, according to the present invention, the positional relationship between the channel opening and the observation window provided on the distal end face of the insertion portion, the two treatment tool insertion channels and the treatment tool guide table are provided. An endoscope which can secure an optimal positional relationship and easily perform treatment can be provided.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view of an endoscope showing one embodiment of the present invention; FIG. 2 is a perspective view showing a vertical treatment tool guide table unit in the endoscope of FIG. 1; FIG. 3 is a cross-sectional view of a main part showing a configuration of a vertical treatment tool guide table and its vicinity in the endoscope of FIG. 1, and FIG. 4 (A) shows a swing angle of a treatment tool in a conventional treatment tool guide table. FIG. 5B is a cross-sectional view of the upper and lower treatment tool guide table showing the swing angle of the treatment tool in the treatment tool guide table of the present invention; FIG. 5B is an endoscope of FIG. FIG. 6 is a side view showing the magnitude relationship between the vertical guide table operation knob and the left and right guide table operation knobs in FIG. 6, FIG. 6 is a front view showing the distal end surface of the distal end portion of the insertion section in the endoscope in FIG. A) performs treatment by inserting grasping forceps into the upper and lower treatment tool guide tables and inserting the high-frequency knife into the left and right treatment tool guide tables. (B) is an endoscope image showing a state in which a grasping forceps is inserted into the left and right treatment tool guide tables, a high-frequency knife is inserted into the upper and lower treatment tool guide tables, and a treatment is being performed; 8 is an explanatory view showing a positional relationship between a treatment instrument guide hole and an observation cover lens in the endoscope of FIG. 1, FIG. 9 is a vertical swing range and a horizontal swing of each treatment instrument during a normal treatment. FIG. 10 is a perspective view of a distal end portion of the endoscope insertion portion showing a movement range, FIG. 10 is a side view showing a state in which a distal end cover of the endoscope in FIG. 1 is removed from the distal end portion of the endoscope, FIG. 12A is a front view showing a transparent cap attached to the endoscope distal end, FIG. 12B is a side view showing a state where the transparent cap is attached to the endoscope distal end, FIG. FIG. 13 is a cross-sectional view showing a state in which a treatment is being performed using the present invention. Perspective view, Figure 14 is a perspective view showing the state of holding the treatment instrument for endoscope holder of FIG 13 showing a state of setting the endoscope holder endoscope with. [Description of Signs] 1 ... Endoscope 2 ... Insertion section 5 ... End section 8 ... Cover lens for observation (observation window) 11 ... 1 treatment tool insertion channel 12... Second treatment tool insertion channel 28... First treatment tool guide hole (opening of treatment tool insertion channel) 42. Opening of treatment instrument insertion channel)

   ────────────────────────────────────────────────── ─── Continuation of front page    (72) Inventor Takatsugu Yamatani             2-43-2, Hatagaya, Shibuya-ku, Tokyo Ori             Inside of Opus Optical Co., Ltd. F-term (reference) 2H040 DA21 DA56                 4C061 FF35 FF43 HH24

Claims (1)

Claims: 1. An endoscope having two treatment instrument insertion channels which are inserted into an insertion portion and open at the distal end surface of the distal end portion of the insertion portion, respectively, wherein the endoscope is disposed on the distal end surface. An endoscope, wherein each opening of the treatment instrument insertion channel is arranged at an equal distance from an observation window.