JP2009142692A - Nose-worn protector for transnasal endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To reduce pain of a patient when transnasally inserting an insertion section of an endoscope, by a simple constitution by preventing the insertion section from being strongly pressed against a nose wing or the like. <P>SOLUTION: This nose-worn protector 10 has a protector body 12 formed with an insertion pathway 11 for inserting the insertion section 2 of the endoscope 1 therein and, when a person wears the protector body 12 on the nose, the insertion pathway 11 is positioned inside the external nostril, however, it has such a length as being short in reaching a portion where the nasal cartilage constituting the nasal meatus such as middle nasal meatus is present. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention is used as an endoscope for upper gastrointestinal tract such as a gastroscope, and is a nasal insertion type endoscope that is inserted into a body cavity nasally. The present invention relates to a nose protection device for securing a passage through which an insertion portion of an endoscope is inserted and for suppressing a nose wing and the like from being pressed and deformed.

  In general, an endoscope for an upper digestive tract or the like is generally an oral insertion in which an insertion portion is guided into a body cavity through the oral cavity. For this reason, a subject who undergoes endoscopic examination holds a mouthpiece in a lying state, and the insertion portion is guided into the body cavity along a path secured by the mouthpiece. When inserted through the oral cavity, when the insertion section passes through the throat, the throat reflex or vomiting reflex occurs due to the insertion section touching the tongue base, giving the subject a feeling of vomiting and painfulness become. And although an anesthetic is used to suppress this pharyngeal reaction and reduce pain, the pain still remains. Furthermore, since the subject holds the mouthpiece, there are problems that it is difficult to talk with the surgeon and the like, and that mouth breathing is difficult.

  As an endoscope insertion path, not only the oral cavity described above but also a transnasal insertion method is possible. In particular, in recent years, the insertion portion of the endoscope tends to be reduced in diameter, and an endoscope having an optimum outer diameter for insertion through the nasal cavity has been put into practical use. For example, Patent Document 1 points out that the nasal insertion method is advantageous from the viewpoint of subject protection. As is clear from Non-Patent Document 1, a clinical example of endoscopy in which a small-diameter insertion portion is used to guide it into a body cavity nasally has been reported.

  In this way, when the insertion part of the endoscope is inserted from the nasal cavity, it does not pass through the throat, so that the pain and burden on the subject are reduced without causing vomiting, etc. Since the minute amount is sufficient, there is an advantage that the subject can have a conversation with the surgeon and the like during the examination, and mouth breathing is also possible. Therefore, it is expected that examinations using a nasal insertion type endoscope will increase in the future.

JP 2005-74035 A

54th Annual Meeting of the Japanese Gastroenterological Endoscopy Society 39 (Suppl.2) 1997 VS6-2

  To insert the insertion part of the endoscope into the body cavity nasally, take a route from the nostril through the middle nasal passage and lower nasal passage, because this route has a narrowed part The outer diameter of the insertion portion must be able to pass through the narrow portion smoothly. However, when the insertion part is inserted nasally, the outer nostril as the entrance of the insertion path has no cartilage or the like on the nose wings that become the walls of the passage, and can be deformed in any direction. It has become. When inserting the insertion portion of the endoscope into the nasal insertion path, for example, the direction of the insertion portion may be changed, or the operator's posture may be changed during the examination. At that time, force acts on the insertion part in the bending direction, twisting direction, etc., and this force may press the nose wing or nasal septum or cause it to be stretched, which may cause pain to the subject. is there. From the viewpoint of transnasal insertion, it is desirable to reduce the diameter of the insertion part, but the thinner the insertion part, the more strongly the patient is pressed against the nasal wing and the nasal septum, causing sharp pain to the subject. There is a problem that there is a risk of it.

  The present invention has been made in view of the above points, and the object of the present invention is to insert the insertion portion into the nose wing or the like when the insertion portion of the endoscope is inserted nasally with a simple configuration. An object of the present invention is to provide a protective jig that prevents the patient from being strongly pressed and reduces pain to the subject.

  In order to achieve the above-described object, the present invention has a protector main body that can be mounted in an outer nostril and into which an insertion portion of an endoscope can be inserted, and the protector main body is attached to the nose. The insertion passage is located inside the outer nostril and has a length that does not reach the site where the nasal cartilage that constitutes the nasal passage is present.

  In the nasal passage composing the nasal insertion route, the nose wing is a part of the passage from the nostril to the nasal vestibule. And it is set as the structure which forms the tunnel-shaped channel | path which inserts an insertion part in the site | part which a nasal cartilage does not exist. As a result, even if a force in the bending direction or torsional direction acts on the insertion section operated by the surgeon, the insertion section bends at the entrance of the insertion passage outside the outer nostril. No longer works. However, the main body of the nasal protector is not inserted to the nasal passage where the nasal cartilage exists. The outer nostril where the nose wing is located is the beginning of the insertion path, the path length is short, and the space shape of the path can be slightly expanded. Therefore, the operation of inserting and removing the nose protection device can be performed easily and smoothly.

  The insertion portion of the endoscope is inserted into the insertion passage formed in the protector body. In order to smoothly guide the insertion portion to the insertion passage, a calling portion in which the inlet side of the insertion passage expands in a funnel shape can be formed. As a result, it is not necessary to increase the diameter difference between the outer diameter of the insertion portion and the inner diameter of the insertion passage. In addition, when this diameter difference is reduced, the space between the insertion portion and the calling portion can function as an anesthetic storage portion, and the anesthetic can be supplied into the nasal cavity by pushing and pulling the insertion portion. Become.

  The protective device main body can be formed of a soft plastic having a certain degree of shape retaining property and cushioning properties in order to exhibit a buffering action of an external force that acts during mounting or insertion operation of the insertion portion. Moreover, by using a material having good heat resistance, it can be formed of a material that can be sterilized, that is, has chemical resistance or autoclave resistance, such as silicon rubber or fluororubber. However, the shape of the insertion path must be stable. Therefore, in order to give the hardness which does not deform | transform the part which comprises an insertion path, it is good also as a structure which forms with a metal, a hard plastic, etc., and covers the circumference | surroundings with a soft plastic, rubber | gum, etc. This nose protection device can be configured to include a protection device main body that forms an insertion path of the insertion portion, a stopper portion, and a drop-off prevention portion.

  The protective device main body has an insertion passage formed therein, and an insertion portion is inserted through the insertion passage. Therefore, the protective device main body is formed of a slippery member or a self-lubricating material so that the insertion operability is good. be able to. It is also possible to apply a lubricant to the surface.

  The stopper portion is for holding the entire nasal protector so as not to be embedded in the nasal cavity by the pushing force when the insertion portion is inserted into the protective device main body. Specifically, for example, a configuration in which a flange portion having an outer shape larger than the outer nostril is continuously provided on the protective device main body can be employed. The insertion portion of the endoscope is inserted into one of the two outer nostrils, but the protective device main body that is inserted into both outer nostrils is formed by the nose protection device so that it functions as a stopper portion. be able to. In this case, any one of the protector main bodies is to be inserted with the insertion portion of the endoscope, and may be inserted in a direction that is easy to insert. The other protective device main body into which the insertion portion is not inserted becomes a breathing passage.

  The stopper portion described above is a mechanism for preventing the nasal protector from being pushed in until it is inserted into the nasal cavity, but the drop-off preventing portion is for holding the nasal protector so that it does not fall off the nose. Is. It is also desirable to hold the nasal protector so that it does not become unstable. Therefore, the drop-off prevention unit exhibits a function of stably holding the nasal protector even during the endoscopy. As an example of this drop-off prevention part, it can be set as the structure which forms an annular | circular shaped bulging part in the outer surface of a protector main body. In this case, the bulging portion has an outer diameter that causes a certain amount of resistance when inserted into the outer nostril. Also, if the bulging part is formed in a wedge shape that tapers from the distal end of the insertion side and is inserted from a reduced diameter part of the distal end, compression is applied when the subject wears the nose protection device. The feeling is reduced. Furthermore, the drop-off prevention part can be configured as a clip-like member that sandwiches the inside and outside of the outer nostril, as well as a configuration that forms a bulging site that causes resistance to dropping inside the outer nostril, and attaches a band. It can also be configured.

  When the insertion portion of the endoscope passes through the insertion passage of the nasal protector, the endoscope is guided to the middle nasal passage or the lower nasal passage, and at this time, the route is changed in direction. In order to smoothly change the direction of the insertion portion, the insertion passage front end portion of the insertion portion in the insertion passage of the nose protection device can be bent. For this purpose, for example, a plurality of slits extending from the front end side of the protective device main body to a predetermined position can be formed.

  As described above, the insertion portion of the endoscope can be smoothly and nasally inserted with a simple configuration, and the insertion portion can be prevented from being directly pressed against the nasal wing and the like, thereby eliminating pain to the subject. Thorough reduction.

It is explanatory drawing which shows the state which wears the nose protector of this invention and inserts the insertion part of an endoscope in a body cavity of a subject. 1 is an external view of a nose protection device showing a first embodiment of the present invention. FIG. 3 is a cross-sectional view of FIG. 2. It is an external view which shows the modification in the 1st Embodiment of this invention. It is an external view of the nose protection device which shows the 2nd Embodiment of this invention. It is a front view of the nose protection device which shows the 3rd Embodiment of this invention. It is a longitudinal cross-sectional view of FIG. FIG. 7 is a left side view of FIG. 6. It is an external view of the nose protection device which shows the 4th Embodiment of this invention. It is an external view of the nose protection device which shows the 5th Embodiment of this invention. It is an external view which shows the structure which mounted | wore the nose protection device shown in FIG. 10 with the band. It is an external view of the nose protection device which shows the 6th Embodiment of this invention. It is sectional drawing of the nose protection device which shows the 7th Embodiment of this invention.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In the figure, reference numeral 1 denotes an endoscope. The endoscope 1 is provided by connecting a main body operation unit 3 to a proximal end portion of an insertion unit 2 to be inserted into a body cavity. The universal cord 4 connected to the processor is extended. The insertion portion 2 is inserted into the upper digestive tract such as the esophagus, stomach, duodenum, etc., and is used for performing a desired examination or treatment. Here, the insertion part 2 is inserted into the body not through the oral cavity of the subject but through the nasal cavity. That is, a route from the outer nostril, which is the entrance of the nasal passage, through the nasal cavity including the middle nasal passage (or the lower nasal passage) and from the nasopharyngeal portion to the esophagus is taken.

  In this way, in the route through which the insertion portion 2 is inserted nasally, the portion of the nasal cavity vestibule from the outer nostril that hits the entrance of this route has a larger space than the subsequent route, and is optional. A flexible nose wing that can move in the direction of the Further, the passage is narrowed from the nasal vestibule toward the middle nasal passage or the lower nasal passage, and the freedom of movement cannot be obtained. Therefore, for example, when the insertion portion 2 is bent at a site outside the nasal cavity in order to change the posture of the surgeon or to control the insertion direction of the insertion portion 2, it is bent suddenly inside the nasal vestibule. Become. As a result, a flexible part such as a nasal wing or a nasal septum may be pressed or stretched, which may place a burden on the subject and cause pain.

  From the above points, the nose protection device 10 is caused to be worn by the subject during insertion of the insertion portion 2 or during examination. The nose protection device 10 is formed with an insertion hole 11 through which the insertion portion 2 of the endoscope 1 is inserted. The insertion hole 11 is deformed into any direction or shape in the nasal passage. The length of the nasal wing extending from the outer nostril to the nasal vestibule is almost the entire length, but the length includes the middle nasal passage and the nasal cartilage that constitutes the nasal passage. As shown in FIG. 3, the hole diameter of the insertion hole 11 of the nose protection device 10 must be larger than the outer diameter of the insertion portion 2 of the endoscope 1, but the diameter difference needs to be too large. Absent. The inlet portion of the insertion hole 11 is expanded in a funnel shape and serves as an introduction calling portion 11 a of the insertion portion 2.

  In the nose protection device 10, a portion where the insertion hole 11 is formed is defined as a protection device main body 12, and a flange portion 13 is continuously provided on the introduction calling portion 11 a side of the protection device main body 12. The flange portion 13 exhibits a function of preventing the nasal protector 10 from being embedded in the nasal cavity when the insertion portion 2 is inserted into the body through the nasal protector 10. The outer diameter is sufficiently larger than the diameter of the outer nostril. Therefore, the flange portion 13 functions as a stopper portion in the nose protection device 10.

  The outer surface of the protector main body 12 bulges so that the substantially intermediate portion thereof has the largest spherical shape in the axial direction. Of the spherical portion, the maximum diameter portion 12M is substantially the same as or slightly larger than the diameter of the outer nostril. Therefore, when the nose protection device 10 is worn on the nose, the outer nostril is worn so as to be slightly expanded by the spherical portion of the outer surface thereof. As a result, when passing through the maximum diameter portion, the nose protection device 10 is stably held while being worn on the nose, and can be prevented from falling off excessively. Therefore, this bulging portion, in particular, the maximum diameter portion 12M functions as a drop-off preventing portion.

  Further, a plurality of slits 14 are provided on the distal end side of the protector main body 12, that is, on the side opposite to the side where the flange portion 13 is provided, by a predetermined length from the end portion in the direction along the axis of the insertion hole 11. Is provided. As a result, when the insertion portion 2 is inserted through the insertion hole 11, the insertion portion 2 can be slightly curved and deformed by the insertion portion 2. As a result, even if there is a deviation between the insertion hole 11 provided in the nose protection device 10 and the insertion path in the nasal cavity, the tip of the insertion hole 11 is corrected so as to follow the passage such as the middle nasal passage. Thus, the insertion portion 2 inserted into the insertion passage 11 can smoothly advance toward the middle nasal passage and the like.

  By using the nose protection device 10 having the above configuration, the pain of the subject can be alleviated during insertion of the insertion portion 2 and during examination. Here, the insertion part 2 of the endoscope 1 may be inserted into the insertion hole 11 of the nose protection device 10 in advance by being worn on the subject's nose. When inserting into the body cavity 2 and inserting it into the body cavity, the insertion operation can be performed smoothly by pulling it toward the main body operating section 3 side of the inserting section 2 without being worn on the nose. And the insertion part 2 is inserted in the object part which should be observed, for example, the inside of an esophagus or a stomach. At this time, if an anesthetic is applied to the outer surface of the insertion portion 2, the pain of the subject can be reduced. And, for example, when xylocaine jelly is used as this anesthetic, since it has a certain degree of viscosity, the retention on the outer surface of the insertion portion 2 is good and it functions as a lubricant. Insertion can be performed more smoothly.

  When the distal end of the insertion portion 2 passes through the middle nasal passage and reaches the vicinity of the pharyngeal nose, the nasal protector 10 is slid from the main body operation portion 3 side of the insertion portion 2 and inserted into the outer nostril. To do. Since the maximum diameter portion 12M of the protector main body 12 has an outer diameter slightly larger than that of the outer nostril, the outer nostril is inserted so as to be expanded, and the flange portion 13 comes into contact with the outer nostril. As a result, the nasal protector 10 is stably held so as not to fall out of the nostril and not to be embedded in the nasal vestibule side.

  In this state, an endoscopic examination is performed. During this examination, bending force or torsional force is applied to the insertion part 2 in order to change the posture of the operator or change the direction of the insertion part 2. May be. The insertion portion 2 is located in a free space at a portion outside the nostril, and the tip from the nostril is restricted by the insertion path. Therefore, when the insertion portion 2 is bent, the insertion portion 2 is bent sharply at a portion of the outer nostril that is the starting end position of the insertion path. However, since this portion of the insertion portion 2 is located in the insertion hole 11 of the nose protection device 10, even if the insertion portion 2 is pressed against the inner wall of the insertion hole 11, a part of the nasal passage is blocked. The pressing force of the insertion part 2 does not act directly on the nose wing or the like that is configured and flexible. Of course, the bending force of the insertion portion 2 eventually reaches the inner wall of the nasal cavity including the nasal wing and septum, but the pressing force is dispersed throughout. Therefore, even if the insertion portion 2 is taken in and out or bent greatly in order to perform endoscopy, the burden on the subject is not so great and pain is alleviated.

  When the insertion part 2 is inserted or when the endoscopy time becomes long, it is necessary to replenish an anesthetic, but at the entrance of the insertion hole 11 of the nose protection device 10 through which the insertion part 2 is inserted. Since the introduction lead-in part 11a which is expanded is formed, the anesthetic can be replenished by storing an anesthetic such as xylocaine jelly at this site. That is, the insertion portion 2 is pushed and pulled during the endoscopic examination, but when the insertion portion 2 is pushed in, the anesthetic penetrates into the nasal cavity. Here, the anesthetic is required only inside the nasal cavity, in particular, to the middle nasal passage and the lower nasal passage. It is possible to spread enough to the part that was done.

  Since the insertion part 2 of the endoscope 1 is inserted through the insertion hole 11 formed in the inner nose protection device 10 in a state in which the nose protection device 10 is mounted, the nose protection device 10 is worn on the nose, Holding as stably as possible is desirable in order to improve the operability of the endoscope 1. Therefore, as shown in FIG. 4, the flange portion 13 can be provided with a clip portion 15 made of an elastic member. If the clip part 15 is configured to be mounted so as to be sandwiched between the nose wing and the nasal septum, the stability of the nasal protector 10 is further improved when the insertion part 2 is inserted.

  Moreover, as a nose protection device drop-off preventing portion, as in the nose protection device 20 shown in FIG. 5, in the protection device main body 22 provided with the insertion hole 21, the insertion portion is continuously provided from the insertion start end side to the flange portion 23. It is good also as a structure which is provided in a part, and an outer diameter is continuously enlarged halfway and the position away from the flange part 23 only by the predetermined space | interval makes the largest diameter part 22M.

  Moreover, as a drop-off prevention part, as shown in FIG. 6 thru | or FIG. 8, it can be set as the structure which can be expanded / contracted. In this case, the nose protection device 30 includes a protection device main body 32 having an insertion passage 31 formed therein, and a flange portion 33 that is connected to one end of the protection device main body 32 and functions as a stopper portion. A bulging portion is not formed on the outer peripheral surface of the main body 32, and a bag 34 in which a flexible member is formed in an annular shape is fixedly provided. This bag 34 expands and contracts by supplying and discharging air, and the bag 34 is contracted before being worn by the subject, and after being installed in the nasal cavity, the bag 34 is expanded, It has a configuration that demonstrates its drop-off prevention function.

  For this purpose, one end of an air supply / discharge tube 35 is connected to the bag 34, and the other end of the supply / discharge tube 35 is connected to the air supply / discharge means 36. The air supply / exhaust means 36 has a valve casing 37 and a luer lock connecting portion 38, and an air pressure supplying means comprising a syringe or the like and an air pressure releasing means comprising a push rod etc. are attached to and detached from the luer lock connecting portion 38. It can be connected as possible. A valve member 40 biased by a spring 39 is mounted on the valve casing 37. The valve member 40 is tapered, and the inner surface near the end of the luer lock connecting portion 38 on the connection side to the valve casing 37 is also a tapered surface. Normally, the valve member 40 is joined to the tapered surface of the luer lock connecting portion 38 to seal the portion from the inside of the bag 34 to the valve casing 37. A communication passage 40 a is provided on the outer peripheral surface of the valve member 40.

  Accordingly, when the air pressure supply means is connected to the luer lock connecting portion 38 and pressurized air is supplied from the air pressure supply means, the valve member 40 moves in a direction against the spring 39 and is pressurized via the communication passage 40a. Air is supplied from the valve casing 37 through the supply / discharge tube 35 into the bag 34, and the bag 34 is expanded. As a result, the nose protection device 30 does not fall off the nose. When the air pressure supply means is removed after the bag 34 is inflated, the valve member 40 moves to the luer lock connecting portion 38 side, the communication passage 40a is closed, and the inside of the valve casing 37 is sealed. Thus, the bag 34 is held in an inflated state.

  In this way, when the bag 34 constitutes the drop-off preventing portion, the bag 34 is inserted into the nostril in a contracted state, so that the nose protection device can be used even if the size of the outer nostril of the subject is different. 30 can be worn, and the bag 34 can be inflated to an appropriate size, so that the drop-off function can be surely exhibited. When the endoscopic inspection is completed, the air pressure releasing means is connected to the luer lock connecting portion 38 and the valve member 40 is pushed in, whereby the air is extracted from the bag 34 and reduced. Thereby, the nose protection device 30 can be easily detached.

  Further, the nose protection device 50 shown in FIG. 9 is configured to be attached to both outer nostrils. In this nose protection device 50, two protective device main bodies 52 each having an insertion hole 51 are provided on the left and right sides, and a flange portion 53 is continuously provided at the tip thereof. The protective device main bodies 52 are connected by a connecting piece 54. Further, the protective device main bodies 52 are provided with clip portions 55 that serve as drop-off prevention portions.

  If comprised in this way, when inserting the insertion part 2 in one protector main body 52, the other protector main body 52 exhibits the function as a stopper. Further, the insertion portion 2 may be inserted into any of the two protective equipment main bodies 52. And the penetration hole 51 in the protector main body 52 of the side by which the insertion part 2 is not penetrated is used for breathing.

  Furthermore, the nose protection device 60 may be configured as shown in FIG. 10, and the band 65 shown in FIG. 11 may be attached to the nose protection device 60. This nose protection device 60 has a flange portion 63 continuously provided at the tip of a protection device main body 62 having an insertion hole 61 therein, and this flange portion 63 protrudes left and right. Band fastening portions 64, 64 made of through holes are formed. And as shown in FIG. 11, the both ends of the band 65 are inserted in the band fastening parts 64 and 64 and made into a loop shape, so that it can be worn on the head of the subject. A buckle 66 is provided at a portion of the band 65 that is folded back at the band fastening portion 64, and the loop portion of the band 65 is reduced or enlarged by the buckle 66. By wearing the band 65 on the head while wearing the protector 60 on the nose, the nose protector 60 can be held in an extremely stable state. As a result, the insertion portion 2 can be easily inserted and removed. A hook-and-loop fastener 67 is provided on the side of the band 65 opposite to the position where the nose protection device 60 is mounted so that the loop can be opened and closed. Thereby, after wearing the nose protection device 60 on the subject, the band 65 can be fastened in a loop shape by the hook and loop fastener 67, and the engagement of the hook and loop fastener 67 is released after the inspection is completed. The nose protection device 60 can be easily removed by removing the loop. A buckle, hook or the like can be used instead of the hook-and-loop fastener 67.

  In addition to the above, the nose protection device shown by the reference numeral 70 shown in FIG. 12 can be used. The nose protection device 70 is composed of a flange portion 73 connected so as to project to the left and right of the distal end of a protection device main body 72 having an insertion hole 71 therein, and both flange portions 73 are connected by a sagittal tape. Can be fixed around the nose.

  Furthermore, as shown in FIG. 13, a nose protection device 80 in which a flange portion 83 that functions as a stopper can be attached to and detached from a protection device main body 82 having an insertion hole 81 can be used. Depending on the shape and size of the flange portion 83, the flange portion 83 can be appropriately replaced and used.

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Insertion part 3 Main body operation part 4 Universal cord 10, 20, 30, 50, 60, 70, 80 Nasal protector 11, 21, 31, 51, 61, 71, 81 Insertion hole 12, 22, 32, 52, 62, 72, 82 Protective equipment main body 12M, 22M Maximum diameter portion 13, 23, 33, 53, 63, 73, 83 Flange portion 14, 55 Clip portion 34 Bag 65 Band

Claims (2)

It can be mounted in the outer nostril, and has a protector body through which the insertion part of the endoscope can be inserted,
The nasal passage is characterized in that when the body of the protective device is put on the nose, the insertion passage is located inside the outer nostril and has a length that does not reach the site where the nasal cartilage that forms the nasal passage is present. Nose protector for insertion type endoscope. The nasal protector for a nasal insertion type endoscope according to claim 1, wherein the entrance portion of the insertion passage forms a calling portion that expands outward.

Images