JP2005230087A - Over-tube - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an over-tube allowing an operator to accurately confirm the position of the distal end of the over-tube by applying X rays to know the position of the inserted over-tube in the intestinal tract on the way of the manual operation of inserting the over-tube into the intestinal tract, or the like. <P>SOLUTION: This over-tube is externally fitted into the insertion part 2 of the endoscope 1, or the like from outside for inserting/guiding the insertion part 2 into a body cavity. The over-tube has a metal ring 18 as an X-ray intransmittable member at the distal end of an over-tube body 12. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an overtube that is externally or transanally inserted into a body cavity and externally fitted to an endoscope or the like that observes the inside of the body cavity.

  As a procedure for inserting a medical endoscope into a deep digestive tract cavity in a body cavity, for example, the small intestine, there are a case where it is inserted orally and a case where it is inserted transanally. In any case, since the intestinal tract is bent flexibly, even if the insertion part of the endoscope is pushed out of the body cavity, the force is not easily transmitted to the distal end part of the insertion part, and it is difficult to insert it deeply. is there.

  Therefore, an endoscope tube is provided at the distal end portion of the endoscope so that the insertion portion of the endoscope can be smoothly inserted into a complicatedly bent intestine, and an overtube (externally inserted into the endoscope insertion portion) A double-balloon endoscope system in which an overtube balloon is provided at the tip of a sliding tube is known (for example, see Patent Document 1).

  This is because after inserting the overtube that serves as a guide when inserting the endoscope insertion portion into the deep part to the deep part of the intestine, the overtube balloon is inflated to fix the overtube balloon to the intestinal tract. In this state, by retracting the overtube, the intestinal tract is bent to insert the endoscope insertion portion deeper.

Also, when the overtube balloon is inflated and the overtube is fixed to the intestinal tract, the balloon is made of a soft material such as latex so as not to place a burden on the intestinal tract and the internal pressure of the balloon is measured. Thus, there is also known one that can control the pressure (see, for example, Patent Documents 2 and 3).
JP 11-290263 A JP 2001-340462 A JP 2002-301019 A

  Patent Documents 1 to 3 are all endoscopes for intestinal tract observation in which an endoscope balloon is fixed to a distal end portion of an endoscope insertion portion. The overtube that guides the endoscope to the intestinal tract is formed of a flexible synthetic resin material so that the endoscope insertion portion and the overtube are pushed forward and deeper in the axial direction while relatively moving forward and backward in the axial direction. I have to.

  By the way, in the middle of the procedure, there is a case where it is confirmed by irradiating X-rays to which position of the intestine the overtube is inserted. However, the overtube is formed of a synthetic resin material that transmits X-rays. There is an inconvenience that it cannot be confirmed. In addition, when the balloon provided on the overtube is inflated, the positional relationship and state between the balloon and the intestinal tract cannot be confirmed.

  The present invention has been made paying attention to the above circumstances, and its purpose is to irradiate X-rays to the position of the intestinal tract where the overtube is inserted during the procedure of inserting the overtube into the intestinal tract or the like. Accordingly, it is an object of the present invention to provide an overtube that can accurately confirm the position of the distal end of the overtube and the balloon.

  In order to achieve the above object, the present invention provides an overtube that is extrapolated to an insertion portion or the like of an endoscope and inserts and guides the insertion portion into a body cavity at the distal end of the overtube body. An X-ray opaque member is provided.

  According to a second aspect of the present invention, a balloon is provided on the overtube main body of the first aspect, and an X-ray opaque member is provided on the distal end side of the balloon.

  A third aspect of the present invention is characterized in that the balloon of the second aspect is formed of a substance mixed with radiopaque fine particles.

  A fourth aspect is characterized in that the radiopaque member according to the first aspect is provided inside the overtube body.

  A fifth aspect is characterized in that the radiopaque member according to the fourth aspect is provided directly below or around the balloon.

  According to the present invention, during the procedure of inserting the overtube into the intestinal tract or the like, the position of the distal end of the overtube and the balloon are accurately determined by irradiating the X-ray to which position of the overtube has been inserted. Thus, there is an effect that the operability can be improved.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 4 show a first embodiment, FIG. 1 is a side view of the entire double-balloon endoscope, and FIG. 2 is a side view of a state in which an overtube is externally fitted to an insertion portion of the endoscope. FIG. 3 is a longitudinal side view of the overtube, and FIG.

  As shown in FIGS. 1 and 2, for example, an endoscope 1 for a small intestine has an elongated flexible insertion portion 2, and a bending portion 3 is interposed at a distal end (tip side) of the insertion portion 2. The tip structure portion 4 is provided. An operation unit 5 is provided at the proximal end (base end side) of the insertion unit 2, and an angle operation knob 6 is provided in the operation unit 5. Furthermore, the operation part 5 is connected to a universal cord 8 having a connector 7 at the distal end.

  The distal end configuration portion 4 of the insertion portion 2 is provided with an observation optical system (not shown) such as an illumination optical system and a solid-state imaging device, and an endoscope balloon 9 is provided at the distal end portion of the insertion portion 2. Yes. This endoscope balloon 9 communicates with an air supply line (not shown) built in the insertion portion 2, is inserted into the universal cord 8 through the operation portion 5, and is connected to an air supply connection port 10 provided in the connector 7. Since it is connected and the ventilation duct is not exposed to the outside, there is an effect that it does not interfere with the procedure. Further, the air supply connection port 10 provided in the connector 7 of the endoscope 1 is connected to an air supply source (not shown) via an air supply tube (not shown).

  The insertion portion 2 is provided with an endoscope overtube 11 that is extrapolated to the insertion portion 2. An overtube balloon 13 is held at the distal end of the overtube body 12, and a grip is held at the proximal end. A portion 14 is provided.

  As shown in FIG. 3, the overtube main body 12 is formed of a multi-lumen tube formed entirely of a synthetic resin material that transmits X-rays, and is over the lumen 15 that passes through the insertion portion 2 of the endoscope 1. An air supply line 16 for supplying air to the tube balloon 13 is provided in the axial direction. The overtube balloon 13 has a cylindrical shape with openings at both ends, and both ends of the overtube balloon are bound by a binding thread 17 and are airtightly fixed in a state of being fitted onto the overtube body 12. The air supply line 16 is connected to an air supply source (not shown) via an air supply tube 16a.

  Further, a metal ring 18 as an X-ray impermeable member is fixed to the inner peripheral surface of the distal end of the overtube main body 12 from the tip of the overtube balloon 13, and a rubber or synthetic resin is attached to the metal ring 18. A hood 19 made of material is fixed. The outer peripheral surface of the hood 19 has a tapered surface that gradually becomes smaller in diameter toward the distal end, and the inner diameter of the distal end portion 19 a is in contact with the outer peripheral surface of the insertion portion 2 of the endoscope 1.

  In addition, a plurality of communication holes 20 are formed in the peripheral wall of the overtube main body 12 at a desired interval in the axial direction, and the outside of the overtube main body 12 communicates with the lumen 15. Further, the gripping portion 14 provided at the proximal end of the overtube main body 12 is provided with an opening portion 21 communicating with the lumen 15, and the opening portion 21 is provided with a base 22. The base 22 is connected by, for example, a suction pump. A cap 23 made of rubber or the like is attached to the proximal end surface of the grip portion 14, and an opening 24 that is in close contact with the outer peripheral surface of the insertion portion 2 of the endoscope 1 is provided in the cap 23.

  Therefore, in a state where the insertion portion 2 of the endoscope 1 is inserted through the overtube body 12, the distal end of the lumen 15 of the overtube body 12 is closed by the hood 19 and the proximal end is closed by the cap 23. In this state, the outer peripheral portion of the overtube body 12 is in communication with the lumen 15 through the plurality of communication holes 20.

  Further, as shown in FIG. 2, an index 25 indicating the insertion limit position of the overtube main body 12 is marked on the outer peripheral surface of the insertion portion 2 of the endoscope 1. The index 25 is usually hidden by the overtube body 12 fitted to the insertion portion 2. However, when the overtube body 12 is advanced and the distal end of the overtube body 12 approaches the endoscope balloon 9, if the overtube body 12 is further advanced, the overtube body 12 causes the endoscope to move through the endoscope. There is a risk of damaging the balloon 9. Therefore, when the grip portion 14 at the proximal end of the overtube body 12 is positioned in front of the index 25, the overtube body 12 is exposed to notify the operator of the insertion limit of the overtube body 12.

  Next, the operation of the double balloon endoscope will be described.

  FIG. 4 shows a procedure for observing the inner wall of the intestinal tract by orally inserting a double balloon endoscope into the small intestine, where a is the esophagus, b is the stomach, and c is the small intestine. First, the overtube main body 12 is inserted into the insertion portion 2 of the endoscope 1, and the air in the endoscope balloon 9 and the overtube balloon 13 is extracted to be in a contracted state.

  Next, as shown in FIG. 4A, the insertion portion 2 of the endoscope 1 is inserted into the body cavity through the patient's mouth, and the bending portion 3 is operated by operating the angle operation knob 6 of the operation portion 5. The insertion part 2 is inserted into the small intestine c through the esophagus a and the stomach b. And when the front-end | tip structure part 4 of the insertion part 2 of the endoscope 1 passes the duodenum, for example, a remote controller etc. are operated and an air supply source is driven.

  As shown in FIG. 4B, when the endoscope balloon 9 is inflated by supplying air to the endoscope balloon 9 via the air supply connection port 10, the endoscope balloon 9 is The distal end component 4 of the endoscope 1 is fixed to the small intestine c while being pressed against the inner wall of the small intestine c. In this state, when the gripping portion 14 of the overtube main body 12 is gripped and the overtube main body 12 is advanced along the insertion portion 2, the distal end of the overtube main body 12 becomes the rear end portion of the endoscope balloon 9. Led up to.

  Next, as shown in FIG. 4C, the remote controller or the like is operated again to supply air from the air supply source to the overtube balloon 13 through the air supply conduit 16. Accordingly, the overtube balloon 13 is inflated and pressed against the inner wall of the small intestine c, and the distal end of the overtube body 12 is fixed. In this state, when the gripping portion 14 of the overtube main body 12 is gripped and the overtube main body 12 is retracted integrally with the insertion portion 2 of the endoscope 1, it is inserted together with the overtube main body 12 by the tensile force. Since the radius of curvature of the portion 2 is large and is in a substantially straight state, it is possible to shorten the small intestine c by removing excessive bending of the small intestine c.

  Next, as shown in FIG. 4D, when the endoscope balloon 9 is deflated by extracting air, the insertion portion 2 of the endoscope 1 is pushed toward the deep portion of the small intestine c. 2 is inserted toward the deep part of the small intestine c while being guided by the overtube body 12.

  And when the front-end | tip structure part 4 of the insertion part 2 of the endoscope 1 advances to the desired position of the small intestine c, as shown in FIG.4 (E), the balloon for endoscopes is again via the air supply line 10. As shown in FIG. Air is supplied to 9 to inflate the endoscopic balloon 9 and press the endoscopic balloon 9 against the inner wall of the small intestine c to fix the tip constituting portion 4.

  In this state, the overtube balloon 13 is deflated by removing the air, and the overtube body 12 is advanced along the insertion portion 2 by grasping the grasping portion 14 of the overtube body 12. Then, when the distal end of the overtube body 12 reaches the rear end of the endoscope balloon 9, the overtube balloon 13 is expanded again as shown in FIG. 4 (F).

  By repeating this operation, the distal end constituting portion 4 of the endoscope 1 can be inserted to the deep portion of the small intestine c. Further, in the case of the above-described procedure, an air supply gas is supplied to the small intestine c from an air supply port provided in the distal end configuration portion 4 of the endoscope 1, and the small intestine c is inflated so that the inner wall of the small intestine c A space is maintained between the outer wall of the overtube body 12 and the outer wall. Then, the overtube main body 12 is pushed forward toward the deep portion, or the overtube balloon 13 is inflated and fixed to the inner wall of the small intestine c, and is pulled toward the hand side to shorten and shorten the small intestine c.

  Further, in the middle of the above-described procedure, there may be a case where the distal end of the overtube body 12 is inserted into the small intestine c to observe where the distal end of the overtube body 12 is inserted. Since the metal ring 18 that does not transmit X-rays is provided, the position of the distal end of the overtube body 12 can be accurately known by X-rays. Therefore, it is possible to improve the operability when pushing the overtube main body 12 deep into the small intestine c.

  Furthermore, since a metal ring 18 that does not transmit X-rays is disposed in the vicinity of the overtube balloon 13 provided in the overtube body 12, the positional relationship and state between the overtube balloon 13 and the intestinal tract can be determined by X-rays. Since it can be gripped accurately, the balloon for overtube 13 can be safely inflated.

  FIG. 4 shows a procedure for orally inserting a double balloon endoscope into the small intestine, but basically the same applies when the double balloon endoscope is inserted into the small intestine via the large intestine transanally. It is.

  In the first embodiment, the metal ring 18 as the radiopaque member is provided inside the distal end of the overtube main body 12, but the mounting structure and shape of the metal ring 18 are not limited. Absent. Further, even if the overtube balloon 13 provided at the distal end of the overtube main body 12 is formed of a material mixed with X-ray opaque particles, the position of the overtube balloon 13 by irradiation with X-rays, that is, The distal end of the overtube body 12 can be easily confirmed.

  FIG. 5 is a longitudinal side view of the endoscope balloon and the overtube body according to the first disclosure. In the present disclosure, the outer diameter of the fixing ring 26 that fixes the end of the endoscope balloon 9 to the insertion portion 2 is A, and a rib 27 is provided inside the distal end of the overtube body 12. When the inner diameter is B, the relationship is A> B.

  According to the disclosed example 1, when the overtube body 12 externally fitted to the insertion portion 2 of the endoscope 1 is advanced and the distal end of the overtube body 12 approaches the endoscope balloon 9, the overtube body 12 is further increased. When the overtube body 12 is moved forward, the endoscope balloon 9 may be damaged by the overtube body 12. However, the rib 27 of the overtube main body 12 abuts against the fixing ring 26 and the overtube main body 12 does not advance any further, so that the endoscope balloon 9 is not damaged, and the rib 27 contacts the fixing ring 26. The operator knows that the overtube main body 12 has reached the insertion limit.

  FIG. 6 shows a second disclosed example, and is a longitudinal side view of the overtube main body. The disclosed example 2 shows a mounting structure of an overtube balloon 28 provided at the distal end of the overtube body 12. The overtube balloon 28 has a cylindrical shape, and its one end opening 28a is tied and fixed to the outer peripheral surface of the overtube main body 12 with a binding thread 29 in an inverted state. Next, the overtube balloon 28 is turned upside down, and the other end opening 28b is tied and fixed to the outer peripheral surface of the overtube main body 12 with the binding yarn 29, whereby the binding yarn 29 of the one end opening 28a of the overtube balloon 28 is secured. Is hidden inside the overtube balloon 28. According to the disclosed example 2, there are less irregularities on the outer surface of the overtube 11 including the balloon, and there is an effect that the frictional resistance can be reduced and cleaning / disinfection can be easily performed when the overtube is inserted.

  According to each of the embodiments, the following configuration is obtained.

  (Supplementary note 1) An overtube that is extrapolated to an insertion portion or the like of an endoscope and inserts and guides the insertion portion into a body cavity, wherein an X-ray opaque member is provided at a distal end of the overtube body. Overtube.

  (Supplementary note 2) The overtube according to supplementary note 1, wherein the overtube main body is an endoscope overtube in which an insertion portion of the endoscope is inserted into a lumen thereof.

  (Supplementary note 3) The overtube according to supplementary note 1, wherein the X-ray opaque member is a metal ring fixed inside the overtube main body, and also serves as a mounting member for a hood provided in the overtube main body. .

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements without departing from the scope of the invention in the implementation stage. Moreover, various inventions can be formed by appropriately combining a plurality of constituent elements disclosed in the embodiment. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, you may combine suitably the component covering different embodiment.

1 is an overall side view of a double balloon endoscope showing a first embodiment of the present invention. The side view of the state which externally fitted the overtube of the embodiment to the insertion part of an endoscope. The longitudinal side view of the overtube of the embodiment. The same embodiment is shown, (A)-(F) is an operation explanatory view of a double balloon type endoscope. FIG. 6 is a longitudinal side view of the endoscope balloon and the overtube main body according to the first disclosed example. FIG. 6 is a longitudinal side view of the overtube main body, showing a disclosure example 2;

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Endoscope, 2 ... Insertion part, 9 ... Endoscope balloon, 12 ... Overtube main body, 13 ... Overtube balloon, 18 ... Metal ring (X-ray impermeable member)

Claims (5)

In an overtube that is extrapolated to an insertion portion of an endoscope, etc. and guides the insertion portion into a body cavity,
An overtube characterized in that a radiopaque member is provided at the distal end of the overtube body.   The overtube according to claim 1, wherein a balloon is provided in the overtube main body, and an X-ray opaque member is provided on the distal end side of the balloon.   The overtube according to claim 2, wherein the balloon is formed of a material mixed with radiopaque fine particles.   The overtube according to claim 1, wherein the radiopaque member is provided inside the overtube main body.   The overtube according to claim 4, wherein the radiopaque member is provided directly below or around the balloon.

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