JP2009142331A - Endoscope insertion aid - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To easily release sticking when a hard part of an endoscope insertion portion gets stuck when pulling the insertion portion and removing it from a body cavity. <P>SOLUTION: In an endoscope insertion aid, an abutting part 16 is formed by being raised from the guide surface of a guide path 11 in a direction crossing the longitudinal axis direction of an operation member 3 at the distal end of the elongated operation member 3 whose distal end side can be inserted into the body cavity, it is configured to abut on the endoscope insertion portion 2 inserted into the body cavity and the insertion portion 2 is released from getting stuck. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an endoscope insertion aid that can release a stack of an endoscope insertion portion inserted into a body cavity.

  In recent years, a technique has been performed in which a patient's outer nostril is inserted into the esophagus and trachea through the pharynx through the nasal cavity. The endoscope used in this case is particularly called a transnasal endoscope, but the configuration of the endoscope is a capture normal flexible endoscope, except that the outer diameter of the insertion portion is reduced. Basically unchanged. 10A and 10B show the usage state of the endoscope. The endoscope insertion portion 50 is connected to a flexible tube portion 51 disposed on the proximal end side, a bending portion 52 connected to a distal end of the flexible tube portion 51, and a distal end of the bending portion 52. The flexible tube portion 51 and the bending portion 52 are connected by a hard connection portion 54. The hard part in the insertion part is the tip part 53 and the connection part 54.

  When this type of endoscope is inserted nasally into the body cavity, as shown in FIG. 10A, the endoscope insertion portion 50 is inserted from the outer nostril e through the nasal cavity a into the pharynx b. When inserting an endoscope, it can be inserted into the narrow pharynx b that is bent downward from the back of the nasal cavity a while being largely curved through the upper region of the relatively wide nasal cavity a, so that a rigid connection is made in the middle of the endoscope insertion part. Even if there is a part, it can be inserted relatively smoothly from the pharynx b to the esophagus and trachea.

  However, since the boundary region between the nasal cavity a and the nasopharynx c is particularly narrow and bent, when the endoscope insertion portion is removed, the hard connection portion 54 in the middle of the insertion portion may be caught and not smoothly removed. is there. The reason for this is that when the endoscope insertion portion is pulled toward the hand side, the flexible tube portion 51 is the shortest horizontal in the nasal cavity a from the position of the nasopharynx c toward the outer nostril e as shown in FIG. When the proximal end of the rigid connecting portion following the flexible tube portion does not come out of the nasopharynx c, the proximal end of the connecting portion is pushed toward the wall of the soft palate f. At the same time, it tends to get caught because it bites into the soft soft palate f. At the same time, the distal end of the rigid connecting portion 54 takes an oblique posture to jump up and is caught on the nasopharyngeal rear wall g. The rigid connection is easy to stack on the pharynx in a posture that crosses the pharyngeal cavity.

  If the endoscope is forcibly pulled in such a state where the hard connection portion is stacked on the pharynx, it cannot be done because the mucous membrane of the pharynx is easily damaged. In the case of a patient having a peculiar morphology of the pharynx or a medical condition such as edema, a more difficult situation is expected, and it takes time to release the stack. In the worst situation, the endoscope insertion portion may be cut with pliers and the insertion portion may be pulled out.

Patent Document 1 is a nasal intubation assisting tool composed of a cylindrical body that guides a nasal endoscope through insertion. Since this auxiliary tool is made of a cylindrical body having a length that can be inserted from the patient's outer nostril to the pharyngeal cavity, the endoscope insertion portion can only be inserted from the outer nostril to the pharyngeal cavity. Further, since this nasal intubation assisting tool is torn the cylindrical body after passing through the endoscope insertion portion and removes it from the patient, it involves a complicated work of tearing the cylindrical body and removing it from the patient.
Patent Document 2 is a guide device that is orally inserted into the trachea, which is installed in the mouth to orally guide the endoscope insertion portion to the pharyngeal cavity.
JP 2002-191552 A Special table 2004-523306

  When the endoscope insertion part is removed from the body cavity, if there is a hard part in the middle of the insertion part, the hard part may be caught on the body cavity wall and stack. The present invention has been made paying attention to such a situation, and when removing the endoscope insertion portion from the body cavity, the endoscope can be easily released when the hard portion of the insertion portion is stacked. An object is to provide a mirror insertion aid.

The present invention provides a long operation member having a guide portion along which an endoscope insertion portion is provided, and a positioning portion that is provided on the proximal end side of the operation member and determines a position for inserting the endoscope insertion portion. A contact portion provided at a distal end portion of the operation member and protruding from a guide surface of the guide portion in a direction intersecting with a longitudinal axis direction of the operation member; and the guide portion provided on the operation member An endoscope insertion assisting tool, comprising: an opening through which the endoscope insertion portion is removed and the endoscope insertion portion can be inserted over a distance from the contact portion.
In addition, the endoscope insertion assisting device is characterized in that a portion forming the contact portion is formed to be transparent through the portion so as to be observable by the endoscope.

  According to the present invention, when the endoscope is removed from the body cavity, when the hard part of the insertion part is stacked on the body cavity wall, the stacked part can be pushed up to release the stacked state without difficulty. The endoscope insertion portion can be easily pulled out from the body cavity without damaging the arm.

  FIG. 1 shows an endoscope insertion aid 1 according to an embodiment of the present invention. The endoscope insertion assisting tool 1 includes an operation member 3 made of a long member having a guide path (guide portion) 11 for passing along the endoscope insertion portion 2, and a proximal end side of the operation member 3 ( The proximal end side) includes an insertion port portion 4 formed at a site and a distal end portion (tip tip portion) 5 formed at a distal end portion of the operation member 3, and these are entirely made of a soft synthetic resin or the like. It is integrally formed. As shown in FIG. 1, the operation member 3 can be bent so as to swell toward the guide surface of the guide path 11. Moreover, you may form the shape of the operation member 3 in a natural state in the shape which swells to the guide surface side of the guide path 11 as shown in FIG.

  As shown in FIG. 2A, the operation member 3 is formed with a substantially U-shaped groove on one side, and a guide path 11 is formed with the inner surface of this groove as a guide surface. The guide path 11 positions and arranges the endoscope insertion portion 2 along the longitudinal axis direction of the operation member 3. Therefore, the operation member 3 constitutes a guide part. Moreover, the hole 12 may be formed in the guide part in the operation member 3 as shown in FIG. 2 (B), or a groove or the like may be formed. Thus, if a hole, a groove | channel, etc. are formed in a guide part, the softness | flexibility of the guide part will increase and the weight of operation member itself can be reduced. The guide portion may be a flat plate shape and may be a spatula shape having the plate surface as a guide surface.

  As shown in FIG. 1, the insertion port 4 is formed of a tubular ring portion 13, and the endoscope insertion portion 2 is inserted into the ring portion to insert the endoscope insertion portion 1 into the endoscope insertion aid 1. A positioning part (positioning means) that defines the initial insertion position is configured. A part of the inner surface (lower part) of the insertion opening 4 is formed so as to continue to the guide surface of the guide path 11. The inner diameter of the ring portion 13 is larger than the diameter of the endoscope insertion portion 2 to be used. Further, the portion of the insertion port 4 serves as a hand side grip when operating the operation member 3. The ring portion 13 may have a substantially U shape or groove shape in which an upper portion of the ring portion 13 is cut out and opened.

  As shown in FIGS. 1 and 2, the distal end portion 5 is a tapered bulging portion that is formed in a solid shape with a rounded shape in which the distal end side is gradually narrowed, and is formed in a so-called bullet shape. And the protrusion part which protrudes and protrudes so that it may cross | intersect with the longitudinal axis direction of the operation member 3 with the front-end | tip part 5 and to stand up from the guide surface of the said guide path 11 is formed, and the contact part 16 which protrudes with this protrusion part is formed. Forming. The abutting portion 16 can be brought into contact with the abdomen (side surface) of the endoscope insertion portion that gets over the abutting portion and is inserted far away.

  Further, as shown in FIG. 3A, the proximal end of the tip portion 5 is a steep wall surface rising from the guide surface of the guide path 11 and has been guided along the guide path 11 by this rising wall surface. An abutting surface 17 is formed to abut the tip of the endoscope insertion portion. The abutting surface 17 serves as a locking portion for positioning the distal end of the endoscope insertion portion. The abutting surface 17 is formed by a hole, a stepped portion, etc., and the distal end of the endoscope insertion portion is fitted into this to be detachably locked, and the endoscope insertion portion 2 is locked to the assembly position on the guide path 11. It is good also as a latching part which can be kept. Moreover, as shown to FIG. 3 (B), it is good also as the slope 18 which consists of a wall surface which goes up to the front end side. Thus, the slope inclined so as to rise gently toward the distal end side is advantageous when the endoscope insertion portion 2 gets over the contact portion 16.

  The distal end portion 5 including the bulging portion 15 is formed transparent so that the inside of the body cavity can be observed through the endoscope. The transparent portion may be only the portion facing the front end surface of the direct-view endoscope, but if it is made of a transparent material including the entire distal end portion 5 or the operation member 3 and the insertion port portion 4, the transparent portion is transmitted. Since the observable range is increased, the blind spot is reduced and the handling operation is easy.

  Further, when the operation member 3, the insertion port portion 4, and the distal end portion 5 are viewed as a whole as shown in FIGS. 1 and 4, the endoscope insertion assisting tool extends from the insertion port portion 4 to the distal end portion 5. In the middle, the guide surface side is notched and the guide surface is exposed. And the opening part 14 which open | releases the guide path 11 outside is formed by the part of this notch shape. For this reason, since the guide surface of the guide path 11 along the endoscope insertion portion 2 is opened, the endoscope insertion portion 2 installed on the guide surface comes out of the guide path 11 and is outside the insertion aid. You can get out. The opening forms a passage through which the endoscope insertion portion can escape from the guide path and exit from the guide passage, so that the endoscope insertion portion can be inserted into the body cavity region ahead of the abutment portion through the passage. become.

  Next, the endoscope insertion part 2 used is demonstrated. As shown in FIG. 4, the endoscope insertion portion includes a flexible tube portion 21 disposed on the proximal end side, a bending portion 22 connected to the distal end of the flexible tube portion 21, and the bending portion. The flexible tube portion 21 and the bending portion 22 are connected by a connecting portion 24. The flexible tube portion 21 is flexible, and the bending portion 22 is a bendable portion. Although the flexible tube portion 21 and the bending portion 22 are not hard portions, the distal end portion 23 and the connecting portion 24 are not bent and do not bend and are hard (rigid). Although not shown, the distal end surface of the distal end portion 23 is provided with an observation window and an illumination window, which is a direct-view endoscope. An endoscope operation unit is provided at the proximal end of the insertion unit 2. As shown in FIG. 5, the endoscope operation unit 25 includes an operation body 26 for forcibly bending the bending portion 22 in the vertical and horizontal directions, a plurality of switch buttons 27, and an air / water supply operation button 28. In addition, general function operation means such as a suction operation button 29 are provided. A universal cord 30 is connected to the main body of the endoscope operation unit 25. The universal cord 30 is connected to an endoscope light source device (not shown) and a video processor. The endoscope here is an electronic endoscope that captures an image by incorporating an image sensor in the distal end portion 23, but may be other types such as a fiber endoscope using an image guide fiber. Further, it may be a side view type or a perspective type endoscope.

  Next, a method for inserting the endoscope insertion portion into the body cavity nasally using the endoscope insertion aid 1 will be described. First, as shown in FIG. 4, the endoscope insertion portion 2 is inserted into the insertion port portion 4, and the endoscope insertion portion 2 is disposed along the guide path 11. The distal end of the endoscope insertion portion 2 is brought into contact with the abutting surface 17 or positioned immediately before the abutting surface 17. In this manner, both the endoscope insertion part 2 and the endoscope insertion part 2 are inserted together from the outer nostril e to the pharynx b in the mounted state. Since the distal end portion 5 of the endoscope insertion assisting tool 1 is transparent, it is possible to observe the front through this, and it is easy to insert. The amount of insertion is restricted where the insertion opening 4 hits the outer nostril e, and at that time, the distal end portion 5 of the endoscope insertion aid 1 is substantially positioned at the pharynx b. Thereafter, the distal end side portion of the endoscope insertion portion is lifted from the guide path 11, separated from the abutting surface 17, and advanced so as to get over the contact portion 16. Then, the endoscope insertion part is inserted from the oropharynx toward the hypopharynx, and the esophagus and trachea are inserted as shown in FIG.

  It is also possible to insert only the endoscope insertion aid 1 first into the nose and then insert the endoscope insertion portion. In this case, only the endoscope insertion aid 1 is first inserted from the patient's nostril e to the region of the pharynx b. Then, the endoscope insertion assisting tool 1 is positioned by placing the insertion opening 4 near the outer nostril e. The operation member 3 is disposed along the upper surface of the hard palate, and the distal end portion 5 is located on the pharynx b. Thereafter, the endoscope insertion portion 2 is inserted into the insertion opening portion 4 and guided from the nasal cavity a to the pharynx b along the guide path 11. Thereafter, as in the case described above, the distal end portion of the endoscope insertion portion is advanced so as to get over the contact portion 16, and is inserted from the oropharynx toward the hypopharynx and inserted into the esophagus and trachea. .

  Then, a predetermined observation, diagnosis, and procedure are performed with an endoscope inserted into the body cavity. After completion of this operation, the endoscope insertion portion is removed. When the endoscope insertion part 2 is removed, the endoscope insertion part 2 is pulled toward the outer nostril e as shown in FIG. From the nasal cavity a to the nasopharynx c, the hard connection portion 24 tends to stack because it tries to pass the shortest course that is linearly approximately horizontal and straight from the nostril e. Since the proximal end of the connecting portion 24 is pulled in an oblique direction close to the horizontal, when it does not come out of the nasopharynx c, it hits the guide path 11 or when the endoscope insertion part is displaced from the guide path 11, the soft palate f It is pressed against the wall and hooked to bite into its soft palate. Further, the distal end of the connecting portion 54 is in a posture to jump up and is caught by the nasopharyngeal rear wall g.

  When a stack occurs in the middle of removing the endoscope insertion portion 2 as described above, the operation member 3 of the endoscope insertion assisting tool 1 is moved to the hand side as shown in FIG. Pull. Then, the contact portion 16 of the distal end portion 5 is pulled up along the inside of the endoscope insertion portion, enters the lower side of the stacked connection portion 54, and pushes up the stacked connection portion and its periphery. Etc., the connection part that has been caught and stuck is detached from the stack part. Further, when the distal end of the connection portion 24 is hit, the distal end is detached from the nasopharyngeal rear wall g. Then, the stacked connecting portion 54 changes its posture in the cavity axis direction in the cavity of the pharynx b, and the stack is released. Further, when the endoscope insertion portion 2 is placed on the guide surface of the guide path 11, the release of the stack is promoted by the movement of the guide surface. That is, the stacking of the connecting portion is released by a synergistic effect of the pushing-up function of the contact portion 16 and the pushing-up function by movement of the guide surface. Therefore, the possibility of damaging the pharyngeal wall caused by forcibly pulling the endoscope insertion portion when stacked is avoided.

  According to this embodiment, by using this endoscope insertion aid, when an unexpected situation occurs where the endoscope insertion portion is stuck near the pharynx, the stack can be easily released. The endoscope insertion portion can be pulled out without breaking the endoscope insertion portion. Even when the distal end portion 23 of the endoscope is stacked on the body cavity wall, the stack can be released in the same manner.

  Note that the contact portion is not limited to being provided at the distal end of the operation portion or the guide portion, but may be formed at a position located on the distal end side in the middle of the operation portion or the guide portion.

  FIG. 8 shows an endoscope removal tool 40 of a type different from that of the present invention, and this endoscope removal tool 40 can be detachably attached to a hard portion in the insertion portion of the endoscope. Is provided. A thread (wire) 42 is connected to the mounting tool 41 as a flexible pulling body. The mounting tool 41 is formed in a ring shape by an elastic member such as rubber, and can be mounted on the hard part by fitting and contracting the hard part in the insertion part 2 of the endoscope. For example, as shown in FIGS. 9 (A) and 9 (B), it is fitted on a rigid connection portion 24 that connects the flexible tube portion 21 and the bending portion 22 in the insertion portion 2 of the transnasal endoscope as described above. Installing.

  When using this endoscope removal tool 40, for example, the attachment tool 41 is fitted and attached to the hard connection portion 24 in the insertion part 2 of the above-mentioned transnasal endoscope, and this attachment tool 41 is fitted. In this state, the insertion portion 2 of the endoscope is introduced into the body cavity (see FIG. 9A). The thread 42 is guided along the insertion part 2 of the endoscope, and the distal end of the thread 42 is out of the body cavity. After the operation in the body cavity by the endoscope is finished, the insertion portion 2 of the endoscope is pulled out.

  When it is difficult to pull out the insertion portion of the endoscope or when the hard portion of the insertion portion is stacked in the middle of the body cavity, as shown in FIG. 9B, the insertion portion is hardened by pulling the thread 42 guided to the outside of the body cavity. Raise the department. Then, a force in the pulling direction acts on the hard part of the insertion part, so that the insertion part can be easily pulled out, and when the hard part of the insertion part is stacked, the stack is released and the insertion part can be easily pulled out from the body cavity.

  Further, the mounting position of the mounting tool with respect to the insertion portion of the endoscope may be the hard distal end portion 23 of the insertion portion. You may mount | wear not only the part which is a hard part but the distal position of the hard part, or the proximal position of the hard part. When the mounting tool is attached to the proximal portion of the hard portion, a force to be pulled up is applied to the insertion portion that is difficult to pull out, and the insertion portion can be easily pulled out. When the mounting tool is attached to the distal part of the hard part, a push-up force is applied to the insertion part that is difficult to pull out, and the insertion part can be easily removed. This endoscope removal tool requires a relatively simple configuration. This endoscope removal tool is easy to handle, can be easily used for various types of endoscopes, and is versatile.

  Although the mounting tool is a ring-shaped member formed of an elastic member such as rubber, it is formed of a ring-shaped elastic member, a part of the member is cut out, and the ring-shaped member is elastically expanded and inserted. It may be configured to be fitted and fixed to the part. Further, the ring-shaped member may be formed so as to be fitted into the insertion portion from the notch portion. You may form a mounting tool with the adhesive tape which can be adhere | attached on the outer periphery of an insertion part. According to the pressure-sensitive adhesive tape, it can be easily mounted, and the mounting position is not selected, so that the insertion portion can be mounted on the distal end side portion. Furthermore, a tape may be used in place of the thread of the endoscope removal tool. If the pulling body is a tape, the area hitting the living body is increased, so the burden is dispersed and damage caused by rubbing the tissue partially can be reduced.

The perspective view of the endoscope insertion auxiliary tool which concerns on embodiment of this invention. (A) is a cross-sectional view of the guide part of the endoscope insertion aid, and (B) is a cross-sectional view of the guide part showing a modification of the guide part in the endoscope insertion aid. (A) is a longitudinal cross-sectional view near the distal end of the endoscope insertion aid, and (B) is a longitudinal cross-sectional view of a modification of the configuration near the distal end of the endoscope insertion aid. The side view which mounted | wore the said endoscope insertion auxiliary tool with the insertion part of the endoscope. Explanatory drawing which inserts the insertion part of an endoscope into a body cavity using the said endoscope insertion auxiliary tool. Explanatory drawing which similarly inserts the insertion part of an endoscope into a body cavity using the said endoscope insertion auxiliary tool. Explanatory drawing which is performing extraction of the insertion part of the endoscope similarly stacked using the said endoscope insertion auxiliary tool. The perspective view of the endoscope extraction tool of another type which assists extraction of the insertion part of the endoscope stacked in the body cavity. (A) (B) is a use explanatory drawing of the above-mentioned endoscope extraction tool. (A) (B) Explanatory drawing of the subject at the time of inserting the insertion part of an endoscope in a body cavity.

Explanation of symbols

a: nasal cavity, b ... pharynx, c ... nasopharynx, e ... outer nostril, f ... soft palate, g ... nasopharyngeal posterior wall 1 ... endoscope insertion aid, 2 ... endoscope insertion part, 3 ... operation member, DESCRIPTION OF SYMBOLS 4 ... Insert port part 5 ... Tip part, 11 ... Guide path, 15 ... Swelling part, 16 ... Projection part, 17 ... Contact surface 21 ... Flexible pipe part, 22 ... Curved part, 23 ... Tip part, 24 ... Connection part.

Claims (2)

A long operation member having a guide section along the endoscope insertion section;
A positioning portion that is provided on the proximal end side of the operation member and defines a position for inserting the endoscope insertion portion;
A contact portion that is provided at a portion located on the distal end side of the operation member, and that protrudes from the guide surface of the guide portion in a direction intersecting the longitudinal axis direction of the operation member;
An opening provided in the operating member, the endoscope insertion portion being removed from the guide portion, the endoscope insertion portion being able to get over the contact portion and inserted in a distance;
An endoscope insertion aid characterized by comprising: 2. The endoscope insertion aid according to claim 1, wherein a portion forming the contact portion is formed to be transparent through the portion so as to be observable by the endoscope.

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