JP2009291372A - Transnasal endoscope guide device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To smoothly insert an insertion part of an endoscope into a nasal cavity insertion path, a narrow and sharply bending path, without injuring the inner wall of the nasal cavity. <P>SOLUTION: A guide sleeve 11 is cylindrical, and composed of a thin-wall part 16 integrally disposed between adjacent rib parts 15 and 15. By gathering all the rib parts 15 at the shaft center position and folding the thin-wall part 16 outward, the guide sleeve is contracted so that the outer diameter becomes smaller than the insertion part 2 of the endoscope 1. The contracted diameter of the guide sleeve is retained by winding a binding tape 20 from outside to form a contracted guide sleeve 11S. The contracted guide sleeve 11S in this state is inserted into the nasal cavity insertion path having the narrow and sharply bending path, and by inserting the insertion part 2 into the contracted guide sleeve 11S, the insertion path of the insertion part 2 can be secured. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention is used as an endoscope for upper digestive organs such as a gastroscope and a duodenoscope, and is inserted intranasally, that is, in a transnasal endoscope, the insertion portion is used as an intranasal insertion path. The present invention relates to a guide device for a nasal endoscope that serves as a guide for insertion.

  An endoscope for an upper digestive organ is generally an oral insertion method in which an insertion portion is guided into a body cavity through the oral cavity. That is, a subject who undergoes an endoscopic examination holds the mouthpiece in a lying position, and the insertion portion is guided into the body cavity along the insertion path via the mouthpiece. When inserted through the oral cavity, when the insertion part passes through the throat, the insertion part touches the tongue base, and the tip of the insertion part pushes the esophageal entrance part, so that the throat reflection or vomiting reflection Cause pain and vomiting.

  As a path through which the endoscope can be inserted, not only the oral cavity but also the nasal cavity can be inserted. However, since the inside of the nasal cavity is narrower than the insertion path of the endoscope through the oral cavity, it is necessary to reduce the diameter of the insertion part of the endoscope having the insertion path in the nasal cavity. An endoscope having a thin insertion portion having a diameter of about 5 mm has been developed, and a transnasal endoscope inserted into an intranasal insertion path has been put into practical use. An endoscope having an insertion portion that is inserted through a nasal cavity insertion path is disclosed in Patent Document 1, for example. In this way, when the insertion part of the endoscope is inserted into the intranasal insertion path, the tongue base is not stimulated and the stimulation to the esophageal entrance part is also less, so the feeling of vomiting is remarkably relieved and the patient suffers. And the burden is reduced. In addition, there are advantages that the subject can have a conversation with the surgeon and the like during the examination, and that mouth breathing is also possible.

  There is a limit even if the diameter of the insertion portion is reduced. That is, an endoscope observation means including an illumination means and an observation means is provided in the insertion portion, and a treatment instrument insertion channel is provided. To prevent these functions from being deteriorated, the distal end portion of the insertion portion is to some extent. The size of is required. That is, an illumination window to which the illumination means is connected and an observation window to which the observation means are attached are formed at the distal end surface portion of the insertion portion, and a treatment instrument outlet is opened. Therefore, an end surface having a predetermined width is required on the distal end surface of the insertion portion, and the transition portion from the outer peripheral edge portion to the outer peripheral surface portion of the distal end surface of the insertion portion has a shape close to an edge. For this reason, the insertion part may be inserted in a narrowed part of the intranasal insertion path so as to be forcedly expanded depending on the nasal cavity structure of the subject.

From the above, if the insertion part is inserted directly into the nasal passage, the outer peripheral edge of the tip of the insertion part may rub the mucous membrane in the nasal cavity, causing damage to the mucous membrane and causing nasal bleeding. There is sex. In particular, the intranasal insertion path has a curved portion at a sharp angle, and the intranasal mucosa itself is easily damaged. Therefore, it is desirable not to insert the insertion portion directly, but to insert it into the intranasal insertion path with the cover attached to the insertion portion. For example, Patent Document 2 discloses a transnasal endoscope that is configured to be inserted with an endoscope cover attached to an insertion portion.
JP 2006-326063 A JP 2006-288823 A

  As in Patent Document 2, when the endoscope cover is attached to the insertion portion, friction to the mucous membrane in the nasal cavity due to the edge at the outer peripheral edge is reduced to some extent, but the endoscope cover is attached to the insertion portion. As a result, the insertion portion becomes thicker by that amount. As described above, the intranasal insertion path is stenosis, and it may be necessary to insert the stenosis part so as to push the stenosis part wide at the insertion part. The bent part is also a narrow part. Therefore, even if the insertion part attached with the endoscope cover can pass through the constriction part, there is a possibility of causing a positional shift between the endoscope cover and the insertion part during that time. There is a problem that the insertion operation into the path becomes difficult.

  The present invention has been made in view of the above points, and the object of the present invention is to narrow the stenosis, and to easily insert the insertion part of the endoscope into the intranasal insertion path, which is a rapidly bent path. In addition, the insertion can be smoothly performed without damaging the inner wall of the nasal cavity.

  In order to achieve the above-described object, the present invention provides a guide device for a nasal endoscope for guiding an insertion portion of a nasal endoscope along its insertion path, and the insertion portion can be inserted therethrough. A guide sleeve made of a flexible cylindrical body that forms a simple passage, the guide sleeve being connected to the thin portion, and a plurality of locations extending in the axial direction from the tip. A material that can be melted in the body in order to hold the guide sleeve in a reduced diameter state. The feature is that the assembly holding member formed in (1) is provided.

  The diameter of the guide sleeve is reduced by concentrating and gathering the thick portion at the axial center position, but the guide sleeve is made compact by folding the thin portion between the thick portions. The folding direction of the thin-walled portion can be inward like a Japanese umbrella, or can be folded outward like a Western umbrella. When it is folded inward, the thin portion is pushed inward, and when it is folded outward, the thin portion is wound around the outer peripheral portion. In any case, the diameter is reduced by folding. The extent to which the diameter can be reduced is determined by the number of thick portions, the size, the thickness of the thin portions, and the like.

  Here, the material that can be dissolved in the body as the assembly holding member is a material that can be decomposed by digestive juice, and specifically, starch, gelatin, and the like are representative. In the case of starch, it can be formed into a tape shape or a sheet shape and further into a lump shape. For example, by winding a tape-shaped member around the outer peripheral surface of the guide sleeve in a reduced diameter state, the thick portion can be held together at the tip. On the other hand, gelatin is a material that can be dissolved in the body and used as a capsule of a medicine. Therefore, in the case of gelatin, it is possible to form the cap member in a predetermined shape, for example, a cap member, and to fit the cap member to the tip of the guide sleeve having a reduced diameter. As a result, the distal end portion of the guide sleeve is held in a concentrated or aggregated state. Further, a lump-like head member can be connected and provided at the tip of the guide sleeve, whereby the tip portion of the guide sleeve can be concentrated and assembled. In this case, the massive head member has a convex curved surface shape. In particular, it is desirable that the tape-shaped member is wound around a guide sleeve having a reduced diameter, and a cap-shaped member is fitted to the tip, or a massive member is mounted.

  In any case, the guide sleeve is reduced in diameter upon insertion, and if the guide sleeve is located in the body cavity, the above-described assembly holding member dissolves. As a result, when a certain amount of time elapses, for example, about 5 minutes to 10 minutes When the time has elapsed, the assembly holding member is dissolved and the assembly state is released, or the state can be easily expanded by an external force. Therefore, when the insertion portion of the endoscope is inserted from the proximal end side of the guide sleeve, the guide sleeve is pushed open by this insertion portion, and an insertion path of the insertion portion is formed in the guide sleeve.

  By reducing the diameter of the guide sleeve that guides the insertion section of the endoscope, it can be easily inserted into the intranasal insertion path, which is narrow and sharply bent. A path is formed in the guide sleeve, and the insertion portion can be smoothly inserted to a predetermined position without damaging the inner wall of the nasal cavity.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, in FIG. 1, 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 apparatus or the processor is extended. The insertion unit 2 is inserted into an upper digestive organ such as the esophagus, stomach, duodenum, etc., and is used for performing a desired examination or treatment. Here, the insertion portion 2 is of a small diameter that can be inserted into the body via the nasal cavity, not the oral cavity of the subject.

  That is, the insertion portion 2 of the endoscope 1 is introduced into the esophagus from the outer nostril, which is the entrance of the nasal passage, through a narrow passage through the nasal cavity including the middle nasal passage or the lower nasal passage, and from the rear nostril through the nasopharynx portion. . This is the intranasal insertion path. In this intranasal insertion route, the portion indicated by A in FIG. 1 is the narrowest portion, and is a route that is largely bent. The insertion portion 2 has a small diameter and is quite rigid. Therefore, when the insertion part 2 is directly inserted into the insertion part 2 in the path bent by this stenosis, specifically, as shown in FIG. 2, the middle turbinate P and the lower turbinate Q between the outer nostril N and If it is going to insert in the passage R which consists of a middle nasal passage in the middle, the direction of the insertion part 2 must be suddenly changed in a narrow space, and the sniper to this passage R must be performed from outside the nasal cavity. Therefore, skill is required, and the insertion operation of the insertion portion 2 becomes difficult.

  From the above, the insertion path of the insertion section 2 is ensured at a stage before the insertion section 2 of the endoscope 1 is inserted into the intranasal insertion path. For this purpose, the transnasal endoscope guide apparatus 10 shown in FIGS. 3 to 7 is used.

  As shown in FIG. 3, the nasal endoscope guide device 10 includes a guide sleeve 11 and a large-diameter portion 12 provided at a proximal end portion of the guide sleeve 11. The large-diameter portion 12 is made of a hard cylindrical member, and has an outer surface having a main body piece 13 having a convex spherical bulge, and the main body piece 13 can be inserted into the outer nostril. The main body piece 13 is formed so that the endoscope introduction hole 13a passes therethrough, and the endoscope introduction hole 13a has a hole diameter sufficiently larger than the outer diameter of the insertion portion 2 of the endoscope 1. It is.

  The guide sleeve 11 is inserted to an appropriate depth in the intranasal insertion path, but the large diameter portion 12 is not necessarily inserted into the outer nostril because of the relationship between the total length of the guide sleeve 11 and the intranasal insertion path. Instead, it can be located outside the nostril as shown by the solid line in FIG. 1, and can also be inserted into the nostril as shown by the phantom line in the figure. A flange portion 14 for a stopper is connected to the end of the main body piece 13, and when the main body piece 13 is inserted into the outer nostril, the flange portion 14 functions as a stopper portion, and the rest is inserted. It will not be possible.

  The guide sleeve 11 is provided with a base end portion connected to the main body piece 13 of the large-diameter portion 12, and as shown in FIG. 4, as a thick-walled portion provided at a certain angle in the circumferential direction. Rib portion 15 and a thin portion 16 provided integrally between adjacent rib portions 15 and 15. The guide sleeve 11 is made of an elastic member such as rubber or made of a soft resin, and the thin portion 16 is highly flexible. On the other hand, the rib portion 15 has flexibility in the bending direction, but still has a certain degree of rigidity. The rib portion 15 is constituted by a protrusion protruding in a convex spherical shape, and has a length extending over the entire length of the guide sleeve 11. In the illustrated guide sleeve 11, six rib portions 15 are provided. Therefore, when the guide sleeve 11 is cylindrical, the rib portions 15 are arranged every 60 degrees. In addition, the number of the rib parts 15 is not limited to this.

  As shown in FIG. 4, the guide sleeve 11 has a substantially cylindrical outer peripheral surface in the expanded diameter state. At this time, when the distal end portion of the rib portion 15 is connected on the inner peripheral side of the guide sleeve 11, a circle having a predetermined radius is formed, is this circle the same as the outer diameter of the insertion portion 2 of the endoscope 1? It is bigger than that. And the thin part 16 interposed between the rib parts 15 and 15 can give the crease | fold F (FIG. 5) in the intermediate part, and it can be now bent along this crease | fold F. Yes. As a result, all the rib portions 15 are concentrated and gathered at the axial center position, so that the guide sleeve 11 can be reduced in diameter as shown in FIG. When the diameter of the guide sleeve 11 is reduced, the guide sleeve 11 is as thin as possible, and the whole is compact. For this reason, when the thin-walled portion 16 is folded outward and wound around the outer peripheral portion, the diameter is reduced and the diameter can be reduced.

  As indicated by reference numeral 11S in FIG. 6, the bundling tape 20 is wound from the outside in a state where the thin portion 16 is folded outward, so that the reduced diameter state is maintained. The bundling tape 20 constitutes a collective holding member, and is thereby temporarily fixed so that the guide sleeve 11 does not expand. The binding tape 20 is made of starch, which is a material that can be decomposed by digestive juice. Therefore, if it is placed in the upper digestive organ for a predetermined time, it will be decomposed and digested. Then, the binding tape 20 is made to have adhesiveness at its end, and the wound portions are overlapped and fixed. The binding tape 20 is formed at one location at least at the distal end portion or in the vicinity of the distal end of the guide sleeve 11, and it is desirable to provide the binding tape 20 at one or more locations on the proximal end side from this position. As a result, the reduced diameter guide sleeve 11S is formed. In addition, it can replace with the tape for binding and can also comprise from what was formed in the tube shape.

  As described above, by setting the guide device 10 for nasal endoscope to the diameter-reduced guide sleeve 11S, it is thinner than the insertion portion 2 of the endoscope 1, and as shown in FIG. N has an outer diameter that can pass without resistance to a passage R formed between the middle nasal turbinate P and the lower nasal turbinate Q and without any resistance, and can be smoothly inserted into the passage R. The reduced-diameter guide sleeve 11S is smoothly guided from the rear nostril to the entrance of the esophagus or the esophagus from the nasopharyngeal portion. The insertion length of the reduced diameter guide sleeve 11 </ b> S can be recognized from the position of the large diameter portion 12. In the state of the reduced diameter guide sleeve 11S, it is inserted to an appropriate insertion depth, and the longest insertion length is up to a position where the large diameter portion 12 is inserted into the outer nostril. Therefore, the large-diameter portion 12 is normally held at the position in front of the nose shown by the solid line in FIG. The position where the large-diameter portion 12 is attached to the outer nostril is the longest insertion length, and no further insertion is possible. Regardless of the position of the large-diameter portion 12, the nasal endoscope guide device 10 is held in a state of being inserted into the intranasal insertion path.

  The diameter-reduced guide sleeve 11S is bundled in a reduced diameter state by the bundling tape 20, but the bundling tape 20 becomes wet and weakened by secretion fluid, anesthetics, etc. in the insertion path. In the next few minutes, the binding is loosened or the binding is released. Therefore, the insertion portion 2 of the endoscope 1 is inserted into the endoscope introduction hole 13 a provided in the main body piece 13 of the large diameter portion 12. As a result, the guide sleeve 11 is pushed and spread, and the insertion portion 2 is smoothly inserted into the guide sleeve 11. Moreover, since the rib portion 15 of the guide sleeve 11 protrudes inward and the inner surface of the rib portion 15 has a convex curved surface shape, the sliding contact portion between the insertion portion 2 and the guide sleeve 11 is substantially this. The tip portion of the rib portion 15 is maintained in a non-contact state with the thin portion 16 in particular, so that the contact area is remarkably reduced and can be smoothly inserted with a light pushing force, and the force in the direction of pushing into the guide sleeve 11 during the insertion process Does not work. The binding tape 20 remaining in the body is eventually digested.

  Thus, since the insertion portion 2 is inserted into the intranasal insertion path in a reduced diameter state, the insertion portion 2 is inserted in a state isolated from the intranasal mucosa in the expanded guide sleeve 11. There is no inconvenience such as nasal bleeding caused by damaging the mucous membrane in the nasal cavity at the edge portion of the distal end of the insertion portion 2. And since the insertion part 2 passes the esophagus, since the wide path | route is ensured, it can introduce | transduce smoothly to the predetermined position in the upper digestive organs to be examined, such as an esophagus, a stomach, and a duodenum.

  Here, the diameter-reduced guide sleeve 11S is in a state of being bound by the binding tape 20, but since the rib portions 15 are assembled, the tip does not have a smooth curved shape. For this reason, although there is little risk of damaging the mucous membrane in the nasal cavity, it may still cause slight damage to the mucous membrane in the nasal cavity depending on the way of insertion, and may cause great irritation to the mucous membrane.

  From the above, as shown in FIG. 8, the cap member 21 having a dome-like convex curved surface shape can be mounted on the tip of the reduced diameter guide sleeve 11S. The cap member 21 is made of, for example, gelatin. The cap member 21 can be formed in the manner of a capsule that stores a medicine. The cap member 21 is mounted so as to be pushed into the tip of the reduced diameter guide sleeve 11S. As a result, the cap member 21 is held in a state of being attached to the tip of the reduced diameter guide sleeve 11S.

  With this configuration, the tip of the reduced-diameter guide sleeve 11S has a convex curved surface shape, so that even if it is pressed against the intranasal mucosa, the intranasal mucosa is not damaged, and the mucous membrane or the like is not damaged. Stimulation can also be minimized. Therefore, the pain of the subject is further reduced. The cap member 21 made of gelatin is finally decomposed and digested, but is not rapidly dissolved like the binding tape 20. However, after the diameter-reduced guide sleeve 11S is inserted to a predetermined position, the insertion portion 2 of the endoscope 1 is inserted into the interior in the same manner as in the first embodiment described above. The cap member 21 is pushed out at the distal end of the insertion portion 2 because it is not fixed to the reduced diameter guide sleeve 11S. As a result, the distal end of the guide sleeve 11 is opened, and the insertion portion 2 is led out from the distal end of the guide sleeve 11. The cap member 21 is made of gelatin and is decomposed and digested in the upper digestive organ.

  Further, instead of the cap member 21, as shown in FIG. 9, the massive head member 22 can be connected to the tip of the reduced diameter guide sleeve 11 </ b> S. Here, the massive head member 22 is made of starch, for example, like the binding tape 20, and is formed into a convex curved shape. Also with this configuration, while the reduced-diameter guide sleeve 11S is inserted along the intranasal insertion path, the massive head member 22 retains its original shape and damages the intranasal mucosa. Therefore, it can be smoothly inserted and the burden on the subject is reduced. Since the massive head member 22 is formed of starch, it quickly dissolves or becomes wet with saliva or the like. Therefore, when the insertion portion 2 is inserted into the guide sleeve 11, The tip of the guide sleeve 11 is pushed open.

  By the way, the passage from the outer nostril to the middle nasal passage is not only a narrow path but also a sharply curved path. Therefore, in order to smoothly pass this rapidly bent portion, the diameter-reduced guide sleeve 11S must have a soft structure. On the other hand, in order to enable smooth insertion into the intranasal insertion path, it is necessary to ensure that the pushing thrust force from the proximal end side of the reduced diameter guide sleeve 11S is exerted to the distal end. Here, since the intranasal insertion path itself is a narrow path surrounded by the inner wall of the nasal cavity, it bends following the bending of the path, but the periphery is regulated by the wall of the intranasal insertion path, so the guide The tip of the sleeve 11 does not swing or bend in any direction, and the directivity of the tip is not lost.

  Therefore, as shown in FIG. 10, the guide sleeve 11 as a whole is configured to have flexibility in the bending direction. However, the guide sleeve 11 does not have an excessively flexible configuration, but generates a pushing thrust from the base end side. Provide the necessary bending rigidity to ensure transmission to the tip. Then, a bending characteristic changing region 23 for reducing the rigidity in the bending direction is formed at a plurality of positions, preferably at a predetermined interval, at least in the vicinity of the tip. Here, the bending characteristic changing region 23 shown in FIG. 10 is configured by forming a plurality of hollow portions 24 having a predetermined depth and a length in the axial direction from the inner surface side of the rib portion 15. Specifically, in the configuration shown in FIG.

  As a result, even if the tip of the diameter-reduced guide sleeve 11S contacts the intranasal mucosa at the sharply bent portion, the portion of the bending characteristic change region 23 described above is not bent and does not push the mucosa. The direction is changed so as to be bent in the direction along the insertion path, and it smoothly advances through this portion. As a result, a path that bends sharply, such as a path from the outer nostril to the middle nasal passage, smoothly passes, and the tip of the guide sleeve 11 quickly reaches the position of the entrance of the nasopharynx or esophagus. Will reach up to.

It is explanatory drawing which shows the state which has inserted the insertion part of the endoscope into the subject's intranasal insertion path. It is an enlarged view of the A section of FIG. 1 which shows the state which has inserted the insertion part of the endoscope into the nasal cavity insertion path. 1 is an external perspective view showing an overall configuration of a guide device for a nasal endoscope showing an embodiment of the present invention. 3 is a cross-sectional view of the guide sleeve in an expanded state. FIG. 3 is a sectional view of the guide sleeve in a reduced diameter state. It is a structure explanatory drawing of a diameter-reduction guide sleeve. FIG. 3 is a cross-sectional view similar to FIG. 2 showing a state in which the reduced diameter guide sleeve is inserted into the intranasal passage. It is sectional drawing of the diameter-reduction guide sleeve which shows the 2nd Embodiment of this invention. It is a side view of the diameter-reduction guide sleeve which shows the 3rd Embodiment of this invention. FIG. 6 is a configuration explanatory diagram of a bending characteristic changing region formed on a guide sleeve.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Insertion part 10 Nasal endoscope guide apparatus 11 Guide sleeve 1S diameter-reduction guide sleeve 15 Rib part 16 Thin part 20 Binding tape 21 Cap member 22 Massive head member 23 Bending characteristic change area 24 Depression part

Claims (5)

A guide device for a nasal endoscope for guiding an insertion part of a nasal endoscope along its insertion path,
A guide sleeve made of a flexible cylindrical body that forms a passage through which the insertion portion can be inserted;
The guide sleeve is composed of a thin portion and a plurality of thick portions connected to the thin portion and extending in the axial direction from the tip, and the thin portion is bent to form the thick portion. It is possible to reduce the diameter by gathering together,
In order to hold the guide sleeve in a reduced diameter state, an assembly holding member made of a material that can be dissolved in the body is provided. The guide device for a nasal endoscope according to claim 1, wherein the dissolvable material is starch or gelatin that is decomposed and digested by a digestive fluid. The guide device for a nasal endoscope according to claim 1 or 2, wherein the assembly holding member is constituted by a tape member wound at least at a distal end of the guide sleeve or a position near the distal end. The guide device for a nasal endoscope according to any one of claims 1 to 3, wherein the collective holding member is configured by a convex curved cap member fixed to a tip end of the guide sleeve. . The warp according to any one of claims 1 to 3, wherein the collective holding member is configured by a massive head member that is attached to a tip of the guide sleeve and is formed to have a convex curved surface shape. Nasal endoscope guide device.

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