JP2010075271A - Endoscope system and assisting tool - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To perform treatment comparable to that by an oral endoscope by a nasal endoscope as well without complicating operations. <P>SOLUTION: The endoscope system 10 has an endoscope 11 and the assisting tool 12. The endoscope 11 is provided with an insertion section 17 to be inserted through one nostril. The assisting tool 12 has an insertion section 35 to be inserted through the other nostril to assist the function of the endoscope 11, and a guide member 37 for lining up the insertion section 17 of the endoscope 11 with the insertion section 35 of the assisting tool 12 and guiding it. When the insertion section 17 is inserted into the guide member 37, the soft section 39 of the insertion section 35 is curved following the curve of the curve section 21 of the insertion section 17, and the distal end face of the endoscope 11 and the distal end face of the assisting tool 12 are turned to the same direction. Thus, even when combining and using the endoscope 11 and the assisting tool 12, since just the curving operation of the endoscope 11 is sufficient, the operation is prevented from becoming complicated. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscope system including a nasal endoscope and an auxiliary tool that assists the function of the nasal endoscope.

  A so-called nasal endoscope is known in which an insertion portion formed in a flexible tubular shape is inserted from an outer nostril to inspect a body cavity of a subject (Patent Documents 1 and 2). Transnasal endoscopes enter the esophagus without touching the tongue base, so pharyngeal reflexes are less likely to occur than oral endoscopes where the insertion part is inserted through the mouth, and there is little nausea. The load on the person is low. Transnasal endoscopes also have the advantage that mouth breathing is possible, anesthetics are smaller than oral endoscopy, and conversation with the subject can be performed during the examination. Therefore, demand has increased in recent years.

A transnasal endoscope is configured in the same way as an oral endoscope. In the internal space of the insertion section, forceps conduits for inserting various treatment instruments, air and water are inserted into the distal end surface of the observation optical system. (Observation window), an air / water supply conduit for feeding into the body cavity, a light guide for guiding the light supplied from the light source device and irradiating it from the tip as illumination light, and the like are housed.
JP 2006-68030 A JP 2007-61377 A

  The transnasal endoscope passes through a narrow and winding insertion path from the outer nostril to the middle nasal passage (lower nasal passage), so the diameter of the insertion part of the oral endoscope is around 9 mm, whereas it is around 6 mm. And the diameter of the insertion part is thinner than the oral endoscope. For this reason, transnasal endoscopes have a narrower space for placing air supply / water supply conduits and forceps conduits in the insertion section than oral endoscopes, and the diameters of these conduits are narrowed. There is a problem that one of the pipelines must be deleted.

  If the diameter of the forceps conduit is reduced, the size of the treatment tool that can be used is limited, leading to a decrease in the amount of biopsy. The forceps conduit is also used as a suction conduit for sucking air, residue, body fluid, and the like accumulated in the body cavity. For this reason, when the diameter of the forceps conduit is reduced, the amount of suction is reduced and it takes time for suction. When the diameter of the air supply / water supply conduit is reduced, the flow rate per unit time of the air and water to be supplied decreases. For this reason, it takes time to expand the stomach to secure a visual field, and to wash away blood and mucus that disturb the observation. When the diameter of the light guide is reduced, the amount of illumination light is reduced and the background is darkened.

  As described above, the transnasal endoscope has an advantage that the load on the subject is low, but has a drawback that there are more functional restrictions than the oral endoscope. For this reason, in nasal endoscopy, when a lesion or the like that is difficult to treat with nasal endoscope is found, treatment must be performed by switching from nasal endoscope to oral endoscope. In some cases, there is a great demand for a transnasal endoscope that can perform the same level of treatment as an oral endoscope.

  As a proposal to meet these demands, an auxiliary device having an insertion portion having substantially the same diameter as that of a transnasal endoscope and having a forceps conduit or a light guide in the insertion portion is used together with the transnasal endoscope. Thus, it is conceivable to assist the function of the transnasal endoscope. For example, if only the forceps conduit is provided in the insertion portion of the assisting device, the diameter of the forceps conduit is orally determined even if the diameter of the insertion portion is substantially the same as the insertion portion of the nasal endoscope. The diameter of the forceps conduit provided in the mirror can be made approximately the same. Therefore, the insertion part of the nasal endoscope is inserted from one outer nostril and the insertion part of the auxiliary tool is inserted from the other outer nostril. When performing the procedure, a biopsy amount equivalent to that of an oral endoscope can be obtained.

  Similarly, if an air supply / water supply conduit is provided at the insertion part of the auxiliary tool, the flow rate per unit time can be made the same level as that of an oral endoscope, and a light guide is provided at the insertion part of the auxiliary tool. If provided, the amount of illumination light can be made comparable to that of an oral endoscope.

  As described above, if a combination of auxiliary tools is used, a transnasal endoscope can perform the same level of treatment as an oral endoscope. However, if a procedure is to be performed using a transnasal endoscope and an auxiliary tool, the insertion parts inserted from the outer nostrils must be operated separately, which makes the operation complicated. Occurs.

  The present invention has been made in view of the above problems, and an object of the present invention is to enable a nasal endoscope to perform the same level of treatment as an oral endoscope without incurring complicated operations. To do.

  In order to achieve the above object, the present invention is used in combination with an endoscope having an insertion portion inserted into a body cavity from one outer nostril, and inserted into the body cavity from the other outer nostril. Thus, in an endoscope system comprising an auxiliary tool having an insertion part for assisting the function of the endoscope, the insertion part of the endoscope is formed into a tubular shape through which the insertion part can be inserted. A guide member is provided which is connected in parallel to the insertion portion and guides the insertion portion of the endoscope in alignment with the insertion portion of the auxiliary tool.

  In addition, it is preferable that an opening for inserting the insertion portion of the endoscope is formed on a side surface of the guide member. Further, the opening is constituted by a through hole formed in a side surface of the guide member, and a guide means for guiding the insertion portion of the endoscope approaching from the rear end side of the guide member to the through hole. Is preferred.

  The endoscope includes an operation unit that is connected to a proximal end portion of the insertion portion and performs a bending operation of the insertion portion, and the insertion portion of the auxiliary tool has a proximal end portion thereof. It is preferable that an attachment portion for detachably attaching to the operation portion is provided.

  Furthermore, a forceps conduit for inserting the treatment instrument into the body cavity, an illuminating means for illuminating the inside of the body cavity by irradiating illumination light, and a sending section for sending gas into the body cavity It is preferable that at least one of a tracheal passage and a water supply conduit for feeding liquid into the body cavity is provided.

  Further, the present invention is used in combination with an endoscope having an insertion portion that is inserted into a body cavity from one outer nostril, and has the function of the endoscope by being inserted into the body cavity from the other outer nostril. In the auxiliary tool having an insertion part to assist, the insertion part of the endoscope is formed in a tubular shape that can be inserted, and is connected in parallel to the insertion part of the auxiliary tool, and the insertion part of the endoscope is A guide member is provided that guides in line with the insertion portion of the auxiliary tool.

  In the present invention, a guide member for arranging and guiding the insertion portion of the endoscope in the insertion portion of the auxiliary tool is provided in the auxiliary tool. Accordingly, if the bending operation of the insertion portion of the endoscope is performed in a state where the insertion portion of the endoscope is inserted through the guide member, the insertion portion of the auxiliary tool can follow the bending of the insertion portion of the endoscope. . Therefore, even when an inspection is performed using an endoscope and an auxiliary tool, it is possible to prevent the operation from becoming complicated.

  As shown in FIG. 1, an endoscope system 10 includes an endoscope 11 that captures an image of a body cavity of a subject, an auxiliary tool 12 that assists the function of the endoscope 11, and illumination in the body cavity. The light source device 13 that supplies the illumination light to the endoscope 11, the processor device 14 that generates the endoscope image, and the monitor 15 that displays the endoscope image generated by the processor device 14. .

  The endoscope 11 is connected to an insertion portion 17 to be inserted into a body cavity of a subject and a proximal end portion of the insertion portion 17, and a hand operation portion 18 for an operator such as a doctor or a technician to perform an operation. And a universal cable 19 connected to the hand operation unit 18 for connecting the endoscope 11 to the light source device 13 and the processor device 14. Further, a forceps conduit 67 (see FIG. 5) for inserting various treatment tools such as forceps and snare from the hand operation section 18 to the distal end of the insertion section 17 is provided inside the endoscope 11. Is provided. The insertion portion 17 is formed in a tubular shape having an outer diameter of about 6 mm. The forceps conduit 67 is formed in a tubular shape having an inner diameter of about 2 mm.

  The auxiliary tool 12 includes an insertion portion 35 to be inserted into the body cavity of the subject, an attachment portion 36 for attaching the proximal end portion of the insertion portion 35 to the hand operation portion 18 of the endoscope 11, and an endoscope. And 11 guide members 37 for guiding the insertion portions 17 in the insertion portion 35 of the auxiliary tool 12 side by side. The insertion portion 35 is formed in a tubular shape having an outer diameter that is substantially the same as or slightly thinner than the insertion portion 17 of the endoscope 11. A forceps conduit 84 (see FIG. 7) having a diameter larger than that of the forceps conduit 67 of the endoscope 11 is provided inside the auxiliary tool 12 from the attachment portion 36 to the distal end of the insertion portion 35. Yes.

  The endoscope 11 is a so-called nasal endoscope that inserts the insertion portion 17 from the outer nostril. In the endoscope 11, the diameter of the insertion portion 17 is smaller than that of an oral endoscope in which the insertion portion is inserted from the mouth. Accordingly, the diameter of the forceps conduit 67 provided in the insertion portion 17 is naturally reduced. For this reason, in the endoscope 11, the size of the treatment tool that can be used is limited as compared with the oral endoscope.

  The endoscope system 10 inserts the insertion portion 17 of the endoscope 11 from one outer nostril, and inserts the insertion portion 35 of the auxiliary tool 12 from the other outer nostril where the insertion portion 17 of the endoscope 11 is not inserted. The guide member 37 is inserted and used in combination. Further, by assisting the function of the forceps conduit 67 of the endoscope 11 with the forceps conduit 84 of the assisting tool 12, even when performing inspection with the endoscope 11 which is a transnasal endoscope, oral endoscope is performed. Make it possible to use a treatment tool that is about the same size as a mirror. In addition, since the internal diameter of the forceps line of a general oral endoscope is about 3.2 mm, it is preferable that the internal diameter of the forceps line 84 of the auxiliary tool 12 is 3.2 mm or more.

  As is well known, the insertion portion 17 of the endoscope 11 includes a distal end hard portion 20, a bending portion 21, and a flexible portion 22. The distal end hard portion 20 incorporates an imaging element, an observation optical system, an illumination optical system, and the like inside a distal end main body formed of a hard metal material or the like.

  The bending portion 21 is configured to bend in four directions, up, down, left, and right in conjunction with operations of the up / down bending operation portion 23 and the left / right bending operation portion 24 provided in the hand operation portion 18. Thereby, the inside of the body cavity can be observed with the distal end surface of the distal end hard portion 20 directed in a desired direction. The soft part 22 is a part that connects the hand operating part 18 and the bending part 21, is formed in a thin and long tubular shape, and has flexibility.

  In addition to the bending operation sections 23 and 24, the hand operation section 18 includes a forceps inlet 25 for inserting a treatment instrument into the forceps conduit 67, and air supply / water supply for supplying air and water into the body cavity. Air supply / water supply button 26, suction button 27 for sucking air and residues accumulated in the body cavity, body fluid, and the like, and water jet port for jetting liquid such as washing water and chemical liquid toward the observation target ( WJ port) 28 and the like are provided. A syringe pump (not shown) is detachably connected to the WJ port 28. Washing water, chemicals, and the like that are sprayed onto the observation target are supplied from this syringe pump. Note that the forceps inlet 25 and the WJ port 28 are usually closed by a detachable stopper.

  The universal cable 19 includes a light guide connector (LG connector) 30 for connecting to the light source device 13 and a video connector (electrical) for connecting to the processor device 14 at the end opposite to the hand operating unit 18. Connector) 31 is provided. The electrical connector 31 is connected to the LG connector 30 via a cord 32. The endoscope 11 is detachably connected to the devices 13 and 14 via these connectors 30 and 31.

  Further, the LG connector 30 is connected to a joint for connecting a water supply tank 33 for storing water for water supply and a joint for connecting a suction device 34 for supplying suction pressure for suction to the endoscope 11. And are provided. The LG connector 30 is connected to the water supply tank 33 via a water supply joint and a water supply tube 33a, and is connected to the suction device 34 via a suction joint and a suction tube 34a.

  The suction joint is connected to a suction pipe formed in the endoscope 11. The suction line is connected to the forceps line 67 in the hand operation unit 18 and is closed by a valve that is interlocked with the pressing operation of the suction button 27. When the suction button 27 is pressed, the suction line is opened, and the path from the forceps line 67 to the suction device 34 via the suction line and the suction tube 34a is connected. When this path is connected, suction is started by the suction pressure of the suction device 34, and air, body fluid, and the like accumulated in the body cavity are sucked from the distal end of the insertion portion 17. Further, when the suction device 34 sucks a liquid such as washing water or body fluid, the liquid is stored in the suction tank 34b. As described above, the forceps conduit 67 also functions as a suction conduit.

  The light source device 13 has a built-in light source lamp that emits illumination light. The light source lamp is disposed so as to face the light incident surface of the connected LG connector 30 and makes illumination light incident on the light incident surface. The illumination light incident on the LG connector 30 is guided to the illumination optical system in the distal end hard portion 20 by a light guide provided in the endoscope 11 and is irradiated from the distal end surface of the distal end hard portion 20.

  Further, the light source device 13 is provided with a pump for supplying air for air supply / water supply to the endoscope 11. The air supplied from the light source device 13 is sent to the air supply conduit formed in the endoscope 11 via the LG connector 30 and also to the water supply tube 33a.

  In the water supply tube 33a, air supplied from the light source device 13 is supplied to the water supply tank 33 to apply pressure to the water supply tank 33, and water in the water supply tank 33 pushed out by the applied pressure. And a conduit for water supply. The water supply conduit is connected to a water supply conduit formed in the endoscope 11 by the LG connector 30.

  The air supply conduit and the water supply conduit of the endoscope 11 are closed by a valve that is interlocked with the pressing operation of the air / water supply button 26. In the center of the air / water supply button 26, a hole for leaking air supplied from the light source device 13 is provided. The valve switches between closing and opening of each pipe line in accordance with the pressing operation of the air / water supply button 26. When the hole of the air / water supply button 26 is closed with a finger, the air supplied from the light source device 13 is sent to the air supply duct and discharged from the distal end of the insertion portion 17. When the air / water supply button 26 is pressed, the air supply line is closed, the water supply line is opened, and the water delivered from the water supply tank 33 is discharged from the distal end of the insertion portion 17.

  In addition, the air supply pipe line and the water supply pipe line of the endoscope 11 are integrated into one as an air supply / water supply pipe line 58 (see FIG. 2) at a portion downstream of the valve. In the insertion portion 17, the air from the light source device 13 and the water from the water supply tank 33 are sent to the distal end of the insertion portion 17 through the same air / water supply conduit 58.

  The processor device 14 is provided with an image processing circuit that performs various kinds of image processing on an imaging signal output from an imaging element provided in the endoscope 11 to generate an endoscopic image. The image processing circuit encodes the endoscopic image into a composite signal or RGB component signal and outputs the encoded signal to the monitor 15. Thereby, an endoscopic image is displayed on the monitor 15.

  The insertion part 35 of the auxiliary tool 12 is composed of a tip part 38 and a flexible part 39. The distal end portion 38 is formed of a hard material such as metal, like the distal end hard portion 20 of the endoscope 11. The soft portion 39 is also configured in the same manner as the soft portion 22 of the endoscope 11 and is formed into a thin and long tubular shape, and has flexibility, and the tip portion 38 and the attachment portion 36 are arranged with each other. Connect between them.

  The attachment portion 36 is formed in a substantially T-shaped three-pronged tube, and is connected to the insertion portion 35 via a central conduit. One end portion of the attachment portion 36 is formed with an inner diameter substantially the same as the outer diameter of the forceps inlet 25 formed in a substantially cylindrical shape. The attachment portion 36 is detachably attached to the hand operation portion 18 by fitting this one end portion to the forceps inlet 25.

  The other end of the attachment portion 36 is a forceps inlet 40 for inserting a treatment tool into the forceps conduit 67 of the endoscope 11 and the forceps conduit 84 of the auxiliary tool 12. As described above, after the auxiliary tool 12 is attached to the forceps inlet 25 of the endoscope 11 by the attachment portion 36, the auxiliary tool 12 is endoscopically viewed through the forceps inlet 40 and the internal conduit of the attachment portion 36 formed in a three-pronged tubular shape. The treatment tool can be selectively inserted into the forceps conduit 67 of the mirror 11 and the forceps conduit 84 of the auxiliary tool 12. The forceps inlet 40 is formed in substantially the same shape as the forceps inlet 25 of the endoscope 11. Thereby, the forceps stopper used for the forceps inlet 25 of the endoscope 11 can be attached to the forceps inlet 40.

  As described above, the forceps conduit 67 of the endoscope 11 also has a function as a suction conduit. When the auxiliary tool 12 is attached to the forceps inlet 25 and the suction button 27 is pressed, the forceps conduit 67 of the endoscope 11 and the forceps conduit 84 of the auxiliary tool 12 are attached via the attachment portion 36 formed in a three-pronged tube. Are connected to each other through the forceps conduits 67 and 84. Thereby, when suction is performed using the auxiliary tool 12 in combination, the amount of suction per unit time can be increased.

  Note that the timing for attaching the attachment portion 36 of the auxiliary tool 12 to the forceps inlet 25 may be before and after the insertion portions 17 and 35 are inserted into the body cavity. In this case, in the latter case, it is desirable that the length of the insertion portion 35 of the auxiliary tool 12 is longer than that of the insertion portion 17 of the endoscope 11 because the operation is easy.

  The guide member 37 is a substantially cylindrical pipe line formed to have a length that is the same as or slightly shorter than the insertion portion 17 of the endoscope 11. The guide member 37 is aligned in parallel with the distal end of the insertion portion 35 of the auxiliary tool 12 and is connected to the insertion portion 35 by bonding or the like. Accordingly, the guide member 37 guides the insertion portion 17 of the inserted endoscope 11 side by side with the insertion portion 35 of the auxiliary tool 12.

  The guide member 37 is made of, for example, a biocompatible plastic material such as polypropylene, polyurethane, or nylon. In addition, as this biocompatible plastic material, a flexible and transparent material is used. By forming the guide member 37 with a transparent material in this way, observation with the endoscope 11 can be performed to some extent even from the inside of the guide member 37.

  A plurality of openings 45 for inserting the insertion portion 17 of the endoscope 11 from the middle of the guide member 37 are provided on the side surface of the guide member 37. The openings 45 are arranged at a predetermined interval and are arranged in a straight line along the axial direction of the guide member 37.

  As shown in FIG. 2, each opening 45 includes a through hole 46 formed in the side surface of the guide member 37, and a pair of guide members (guide means) 47 for guiding the insertion portion 17 to the through hole 46. 48. The through hole 46 is formed in an elliptical shape having a major axis directed in a direction substantially orthogonal to the axial direction of the guide member 37. The through hole 46 has a length on the long axis side slightly larger than the diameter of the insertion portion 17 so that the insertion portion 17 can be easily inserted. The through hole 46 is covered with the guide members 47 and 48. Thereby, when the guide member 37 is inserted into the body cavity, body fluid or the like is prevented from easily entering the guide member 37.

  Each guide member 47, 48 is cut obliquely at the rear end side of the guide member 37. And each guide member 47 and 48 is piled up with the long side of each other facing outward like a collar of a kimono. As shown in FIG. 3, the guide members 47 and 48 are attached so as to float slightly from the side surface of the guide member 37.

  By configuring the guide members 47 and 48 in this way, the entrance of the opening 45 becomes wider toward the rear end side of the guide member 37, and when the insertion portion 17 is brought closer from the rear end side of the guide member 37, The distal end of the insertion portion 17 is caught, and the insertability of the insertion portion 17 with respect to the through hole 46 can be improved.

  When the insertion portion 17 is inserted into the guide member 37 from the opening 45, first, as shown in FIG. 3A, the insertion portion 17 is opened from the rear end side along the guide member 37. Move closer to. Then, the insertion portion 17 is inserted between the guide members 47 and 48, and the insertion portion 17 is roughly positioned with respect to the opening 45. Thereafter, as shown in FIG. 3B, the distal end of the insertion portion 17 is pushed into the guide members 47 and 48 while the side surface of the guide member 37 is pushed down. When the insertion portion 17 is further moved to the distal end side from this state, the distal end of the insertion portion 17 is guided to the through hole 46 by the guide members 47 and 48, and as shown in FIG. Then, the insertion portion 17 is inserted into the guide member 37.

  As shown in FIG. 4, an edge portion 50 whose diameter is slightly narrowed and an opening 52 that exposes the distal end surface 20 a (see FIG. 6) of the insertion portion 17 are formed at the distal end of the guide member 37. . The diameter of the opening 52 is slightly narrower than the diameter of the insertion portion 17 by the edge 50. As a result, the edge portion 50 comes into contact with the distal end surface 20 a of the insertion portion 17 inserted through the guide member 37 and prevents the insertion portion 17 from protruding. And the guide member 37 can hold | maintain in the state which aligned the front-end | tip of each insertion part 17 and 35 by making the front-end | tip surface 20a of the insertion part 17 contact | abut to the edge part 50 in this way.

  The insertion part 35 and the guide member 37 of the auxiliary tool 12 are inserted from the other outer nostril where the insertion part 17 of the endoscope 11 is inserted from one outer nostril. At this time, the insertion portion 35 and the guide member 37 are inserted so that their respective distal ends are located in a range from the rear nostril to the esophagus. Thereafter, the insertion portion 17 of the endoscope 11 is inserted into the guide member 37 from the opening 45 at an arbitrary position. And the front end surface 20a is contact | abutted to the edge part 50, and it hold | maintains in the state in which the front-end | tip of each insertion part 17 and 35 was arrange | equalized.

  In this way, if the insertion portion 17 is inserted into the guide member 37 and is held with the tips of the insertion portions 17 and 35 aligned, the bending portions associated with the bending operations of the bending operation portions 23 and 24 are performed. 21, the flexible portion 39 of the insertion portion 35 is curved, and the distal end surface 20a of the endoscope 11 and the distal end surface 38a (see FIG. 8) of the auxiliary tool 12 are directed in the same direction. As a result, even when the endoscope 11 and the auxiliary tool 12 are used in combination, only the bending operation of the endoscope 11 is required, so that the operation can be prevented from becoming complicated.

  As shown in FIG. 5, the flexible portion 22 of the endoscope 11 has a screw tube 60 called a flex that protects the inside while maintaining flexibility in order from the inside, and the outer layer 62 covered on the screw tube 60. It is composed of a flexible tube 63 consisting of three layers: a net 61 called a blade for holding the resin, and an outer layer 62 on which the resin is deposited on the net 61.

  Inside the flexible tube 63, there are light guides 64 and 65, an angle wire 66, a forceps conduit 67, an air / water supply conduit 68, a multi-core cable 69, and a water jet conduit (WJ conduit) 70. Etc. are provided. The light guides 64 and 65 guide the illumination light supplied from the light source device 13 to the illumination optical system of the distal end hard portion 20. The angle wire 66 is configured such that two angle wires for up and down and left and right are respectively wound around two pulleys interlocking with the operation of the bending operation parts 23 and 24 and their tips are inserted toward the bending part 21. Therefore, there are four inside the flexible tube 63, each of which is inserted into the tight coil pipe 66a.

  The forceps conduit 67 guides the treatment tool inserted from the forceps inlet 25 or the forceps inlet 40 to the distal hard portion 20. The air / water supply pipe 68 sends air or water supplied in response to a pressing operation of the air / water supply button 26 to the hard tip portion 20. The multi-core cable 69 is a cable for mainly sending a signal for driving the imaging sensor from the video signal processing unit and sending an imaging signal obtained from the imaging sensor to the video signal processing unit. The cross-sectional shape is covered with a protective coating. The WJ conduit 70 sends liquid such as water and chemicals supplied from the syringe connected to the WJ port 28 to the hard tip portion 20.

  As shown in FIG. 6, an observation window 72, a pair of illumination windows 73 and 74, a forceps outlet 75, an air / water supply nozzle 76, and a water jet nozzle are provided on the distal end surface 20 a of the distal end rigid portion 20 of the endoscope 11. (WJ nozzle) 77 and the like are provided. In the observation window 72, a part of the observation optical system for taking in image light from the observation object is arranged. The illumination windows 73 and 74 are provided on both sides of the observation window 72 and irradiate light from the light source device 13 supplied via the light guides 64 and 65 toward the observation target.

  The forceps outlet 75 leads the distal end of the treatment tool inserted into the forceps conduit 67. The air / water supply nozzle 76 injects air or water sent from the air / water supply pipeline 68 in response to the pressing operation of the air / water supply button 26. The injection port of the air / water supply nozzle 76 is formed such that the air or water to be injected is directed toward the observation window 72. As a result, the observation window 72 is washed with air or water jetted from the air / water supply nozzle 76, and the dirt and the like adhering to the observation window 72 can be washed away. The WJ nozzle 77 ejects a liquid such as cleaning water or a chemical liquid sent from the WJ pipe 70. The ejection port of the WJ nozzle 77 is formed in the direction of the optical axis of the observation window 72, and directly sprays the liquid to be ejected onto the observation target.

  As shown in FIG. 7, the flexible portion 39 of the assisting tool 12 is covered with a flexible tube 83 composed of three layers of a screw tube 80, a net 81, and an outer layer 82, similar to the flexible portion 22 of the endoscope 11. It has been broken. The screw tube 80 protects the inside while maintaining flexibility. The net 81 is covered on the screw tube 80 and holds the resin of the outer layer 82. The outer layer 82 is obtained by depositing a resin on the net 81.

  In this flexible tube 83, a forceps conduit 84 made of a synthetic resin flexible tube is provided. The forceps conduit 84 guides the treatment instrument inserted from the forceps inlet 40 to the distal end portion 38. Further, as shown in FIG. 8, a forceps outlet 86 for leading the distal end of the treatment instrument inserted into the forceps conduit 84 is formed on the distal end surface 38 a of the distal end portion 38.

  Returning to FIG. 7, the guide member 37 includes a thin wall portion 90 formed in a substantially cylindrical shape and eight ribs 92 formed on the inner surface of the thin wall portion 90. As described above, the thin wall portion 90 and each rib 92 are made of a biocompatible plastic material and have flexibility. The thickness of the thin wall portion 90 is about 0.3 mm. The ribs 92 are formed in a cylindrical convex shape along the axial direction of the guide member 37, and are arranged at equal intervals on the inner surface of the thin wall portion 90. The protruding amount of each rib 92 from the thin wall portion 90 is about 0.5 mm. The diameter of the inscribed circle IC with respect to each rib 92 is about 6.2 mm, and is slightly larger than the diameter of the insertion portion 17 so that the insertion portion 17 of the endoscope 11 can be easily inserted.

  If the entire guide member 37 is formed with the thickness of the thin wall portion 90, the guide member 37 has insufficient strength, and the guide member 37 is inserted when the insertion portion 17 of the endoscope 11 is inserted from the opening 45. It is difficult to insert by bending. On the other hand, if the entire guide member 37 is formed with the thickness of the rib 92, the strength is increased, but the flexibility is lowered. Therefore, when the insertion portion 35 and the guide member 37 are inserted into the body cavity. Or adversely affects the bending operation.

  On the other hand, if the thin wall portion 90 and each rib 92 constitute the guide member 37, the strength can be increased while maintaining flexibility, which adversely affects the insertion into the body cavity and the bending operation. Therefore, the insertability of the insertion portion 17 can be improved. Further, if each rib 92 is provided on the inner surface of the thin wall portion 90, the contact area with the insertion portion 17 inserted into the thin wall portion 90 can be reduced, so that the insertability of the insertion portion 17 with respect to the guide member 37 is further improved. be able to.

  As shown in FIG. 9, the guide member 37 configured as described above is inserted from the external nasal cavity together with the insertion portion 35 in a folded state along the outer surface of the insertion portion 35. By doing so, even when the insertion portion 35 and the guide member 37 are simultaneously inserted from the outer nostril, the guide member 37 can be inserted without being in the way.

  Next, the operation of the endoscope system 10 configured as described above will be described with reference to the flowchart shown in FIG. In the transnasal endoscopy, as a pretreatment, in order to insert the insertion portion 17 of the endoscope 11, an anesthesia is performed from the nasal cavity of the nostril to the middle (lower) nasal passage and an insertion test is performed. The nasal cavity having an insertion path through which the unit 17 can be inserted is determined. Pretreatment is performed in a sitting or supine position.

  After performing the pretreatment, the subject is placed in the supine position or the left-side recumbent position, and the insertion portion 17 of the endoscope 11 is inserted from one nostril. Then, the path to the stomach or duodenum is observed while the insertion portion 17 is sequentially fed into the body cavity.

  If it is determined that treatment or treatment is not necessary by observing the duodenum or stomach, the insertion portion 17 of the endoscope 11 is pulled out from the body cavity, and the examination is terminated. Further, when a lesion is found and treatment or treatment can be performed using the small-diameter forceps conduit 67 of the endoscope 11, a treatment such as a small snare or a biological forceps is performed using the forceps conduit 67. A device is inserted for treatment or therapy.

  When it is determined that treatment or therapy cannot be performed in the forceps conduit 67 of the endoscope 11, the auxiliary tool 12 is used together. When the auxiliary tool 12 is used together with the endoscope 11, first, the insertion part 35 of the auxiliary tool 12 is inserted into the other nostril, so that the nasal cavity of the other nostril is anesthetized. Next, the insertion portion 17 of the endoscope 11 is pulled back so that the distal end surface 20a is positioned in the range from the rear nostril to the esophagus.

  After the insertion portion 17 is pulled back, the insertion portion 35 and the guide member 37 of the assisting tool 12 are inserted from the other outer nostril, and their tips are positioned in the range from the rear nostril to the esophagus. At this time, as shown in FIG. 9, the guide member 37 is folded so as to be along the outer surface of the insertion portion 35.

  When the insertion portion 35 and the guide member 37 are inserted, the opening 45 in the range from the rear nostril to the esophagus is observed with the endoscope 11, and the insertion portion 17 of the endoscope 11 is guided through the opening 45 to the guide member. It inserts in 37 (refer FIG. 3). The insertion portion 17 inserted into the guide member 37 is guided side by side with the insertion portion 35 of the auxiliary tool 12, and advances while the folded guide member 37 is spread to bring the distal end surface 20 a into contact with the edge portion 50. As a result, the distal end surface 20a is exposed through the opening 52, and the distal ends of the insertion portions 17 and 35 are held in an aligned state.

  Thereafter, the attachment portion 36 of the auxiliary tool 12 is fitted into the forceps inlet 25 of the endoscope 11, and the proximal end portion of the insertion portion 35 of the auxiliary tool 12 is attached to the hand operation portion 18 of the endoscope 11. When the attachment portion 36 is attached to the forceps inlet 25, the insertion of the insertion portions 17 and 35 and the guide member 37 is started.

  When inserting the insertion portions 17 and 35 and the guide member 37, the bending operation portions 23 and 24 are operated while viewing the screen of the monitor 15, and the insertion is performed while the bending portion 21 of the endoscope 11 is bent. To go. At this time, since the flexible portion 39 of the auxiliary tool 12 is in close contact with the bending portion 21 of the endoscope 11 by the guide member 37, the bending portion 21 bends together with the bending portion 21 of the endoscope 11. 11 is inserted following the insertion of the insertion portion 17. As a result, the insertion part 35 of the auxiliary tool 12 can be inserted together only by inserting the insertion part 17 of the endoscope 11 alone, and the operation can be performed even when the endoscope 11 and the auxiliary tool 12 are used in combination. Is prevented from becoming complicated.

  When each insertion portion 17 and 35 and the guide member 37 are inserted and an affected area that needs to be treated or treated is displayed on the screen of the monitor 15, a treatment tool such as a snare or biopsy forceps is provided on the attachment portion 36. The forceps inlet 40 is inserted into the forceps conduit 84 of the auxiliary tool 12. Then, the distal treatment member of the treatment tool, for example, a pair of forceps cups or a loop for squeezing is led out from the forceps outlet 86 of the auxiliary tool 12 to perform treatment or treatment.

  A biopsy forceps described as an example of a treatment tool generally has an operation wire having a pair of forceps cups attached to the tip of the biopsy forceps so as to be freely opened and closed, and the rear end of the operation wire is positioned outside the forceps inlet. By moving forward and backward in the direction, the forceps cup is opened and closed in a hook shape by the link structure provided in the distal end portion of the flexible sheath. Biopsy forceps are mainly used for the purpose of tissue collection, and the inner diameter of a compatible forceps conduit often requires, for example, 2.8 mm or more.

  In addition, a snare is generally configured such that a squeezing loop formed by bending an elastic wire enters and exits the sheath tip by operation from the sheath side, and the squeezing loop is formed in the sheath. In the state of being pulled in, it is elastically deformed into a constricted state, and when it is pushed forward from within the sheath, it expands into a loop-like shape. When polypectomy is performed with a snare, the root portion of the polyp is properly tightened with a squeezing loop, and then a high-frequency current is applied to the squeezing loop to make contact with the squeezing loop. A part of living tissue is cauterized and cut and coagulated simultaneously. Many of these snares require an inner diameter of a compatible forceps conduit of, for example, 2.8 mm or more.

  Such a treatment tool such as a snare or a biopsy forceps is used by using the forceps conduit 84 of the auxiliary tool 12, for example, tissue sampling (biopsy), removing a foreign body, stopping bleeding, removing a tumor, removing a gallstone Treatment and treatment such as crushing. Further, when it is desired to suck in body dirt, blood, or other body fluids, when the suction button 27 of the hand operation unit 18 is pressed, suction is performed not only from the forceps outlet 75 of the endoscope 11 but also from the forceps outlet 86 of the auxiliary tool 12. Therefore, rapid suction can be performed, and suction from both forceps outlets 75 and 86 can be performed simultaneously, so that a large amount of living tissue can be collected.

  After the treatment or treatment is completed, the treatment tool is pulled out from the forceps inlet 40 of the auxiliary tool 12, and then both the insertion portions 17, 35 and the guide member 37 are slowly pulled out. In the middle of this, for example, before passing through the range from the rear nostril to the esophagus, the insertion portion 17 of the endoscope 11 is pulled out from the guide member 37, and the state where the insertion portions 17 and 35 are connected is released. Then, after the insertion portion 17 is pulled out from the guide member 37, the insertion portions 17 and 35 are individually pulled out in the order of the auxiliary tool 12 and the endoscope 11. Finally, the attachment part 36 of the auxiliary tool 12 is removed from the forceps inlet 25 of the hand operation part 18.

  By the above, the test | inspection at the time of using the endoscope 11 and the auxiliary tool 12 in combination is complete | finished. If it is known from the beginning that treatment or therapy cannot be performed using the forceps conduit 67 of the endoscope 11, the assisting tool 12 may be used from the beginning.

  In the above-described embodiment, the guide members 47 and 48 stacked like a kimono collar are shown as guide means. However, the guide means is not limited to this, and the insertion portion 17 approaching from the rear end side is not limited to this. Any shape can be used as long as it can be guided.

  In the above embodiment, the edge portion 50 is provided at the tip of the guide member 37 so that the insertion portions 17 and 35 are held in a state where the tips are aligned. Alternatively, the insertion portion 17 may be removed.

  In the above-described embodiment, the guide member 37 having the same length as the insertion portion 17 or slightly shorter is shown. However, the guide member is not limited to this, and for example, only the distal end portion of the insertion portion 17 is inserted. It may be a short one. In addition, when making a guide member short, since the insertion part 17 should just be inserted from the opening formed in the edge part, it is not necessary to provide the opening part 45 in the side surface of a guide member.

  In each of the embodiments described above, the forceps conduit 84 is provided in the auxiliary tool 12 and assists the function of the forceps conduit 67 of the endoscope 11. However, the present invention is not limited to this. May be provided to assist the functions of the light guides 64 and 65 of the endoscope 11, or the auxiliary tool 12 may be provided with an air supply / water supply conduit so that the air supply / water supply conduit 68 of the endoscope 11 is provided. The function may be assisted, or the auxiliary tool 12 may be provided with a WJ conduit to assist the function of the WJ conduit 70 of the endoscope 11. Furthermore, these may be combined and provided in the auxiliary tool 12 to assist a plurality of functions of the endoscope 11.

  In the endoscope 11, which is a transnasal endoscope, the diameters of the light guides 64 and 65, the air / water supply pipe 68, and the like are narrower than those of the oral endoscope as in the forceps pipe 67. Many transnasal endoscopes do not include the WJ conduit 70 and the WJ nozzle 77. Reducing the diameters of the light guides 64 and 65 causes a decrease in the amount of illumination light and the light distribution characteristics, resulting in a dark background. In addition, the reduction in the diameter of the air / water supply conduit 68 causes a decrease in the flow rate of air or water to be supplied per unit time, and it takes time to expand the stomach and clean blood and mucus. If the WJ pipe 70 is not provided, it is not possible to inject cleaning water or chemicals.

  Therefore, if a light guide is provided in the auxiliary tool 12, the amount of illumination light can be improved, and inspection can be performed with brightness and light distribution characteristics comparable to those of an oral endoscope. Further, if the auxiliary tool 12 is provided with an air supply / water supply conduit, the flow rate per unit time of the fluid to be fed can be made comparable to that of the oral endoscope. Furthermore, if the auxiliary tool 12 is provided with a WJ conduit, the amount of liquid ejected as a water jet can be made comparable to that of an oral endoscope.

  In each of the above embodiments, the proximal end portion of the insertion portion 35 is detachably attached to the hand operation portion 18 of the endoscope 11 via the attachment portion 36. However, the present invention is not limited to this, and the base portion of the insertion portion is not limited thereto. It is good also as a structure which does not attach an edge part.

It is explanatory drawing which shows the structure of an endoscope system roughly. It is a fragmentary perspective view which shows the structure of an opening part roughly. It is explanatory drawing which shows roughly the procedure at the time of inserting the insertion part of an endoscope in a guide member. It is a fragmentary sectional view which shows the structure of the front-end | tip part of an auxiliary tool. It is sectional drawing which shows schematically the structure in the soft part of an endoscope. It is explanatory drawing which shows schematically the structure of the front end surface of the insertion part of an endoscope. It is sectional drawing which shows schematically the structure in the soft part of an auxiliary tool. It is explanatory drawing which shows schematically the structure of the front end surface of the insertion part of an auxiliary tool. It is explanatory drawing which shows the state which folded the guide member. It is a flowchart which shows roughly the test | inspection procedure of an endoscope system.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Endoscope system 11 Endoscope 12 Auxiliary tool 17 Insertion part 18 Hand operation part (operation part)
35 Insertion part 36 Attachment part 37 Guide member 45 Opening part 46 Through hole 47, 48 Guide member (guide means)

Claims (6)

An endoscope having an insertion portion to be inserted into a body cavity from one nostril;
In an endoscope system comprising an auxiliary tool that is used in combination with the endoscope and has an insertion portion that assists the function of the endoscope by being inserted into a body cavity from the other nostril.
The insertion portion of the endoscope is formed into a tube that can be inserted, and is connected in parallel to the insertion portion of the auxiliary tool, and guides the insertion portion of the endoscope side by side in the insertion portion of the auxiliary tool. An endoscope system comprising a member.   The endoscope system according to claim 1, wherein an opening for inserting the insertion portion of the endoscope is formed on a side surface of the guide member.   The opening includes a through hole formed in a side surface of the guide member and guide means for guiding the insertion portion of the endoscope approaching from the rear end side of the guide member to the through hole. The endoscope system according to claim 2. The endoscope has an operation part that is connected to a proximal end part of the insertion part and performs a bending operation of the insertion part,
The inner part according to any one of claims 1 to 3, wherein the insertion part of the auxiliary tool is provided with an attachment part for detachably attaching the base end part to the operation part. Endoscopic system.   A forceps conduit for inserting the treatment instrument into the body cavity, an illuminating means for illuminating the inside of the body cavity by irradiating illumination light, and an air supply conduit for sending gas into the body cavity The endoscope system according to any one of claims 1 to 4, wherein at least one of water supply conduits for feeding liquid into the body cavity is provided. Used in combination with an endoscope having an insertion portion inserted into the body cavity from one outer nostril, and having an insertion portion that assists the function of the endoscope by being inserted into the body cavity from the other outer nostril In assistive devices,
The insertion portion of the endoscope is formed into a tube that can be inserted, and is connected in parallel to the insertion portion of the auxiliary tool, and guides the insertion portion of the endoscope side by side in the insertion portion of the auxiliary tool. An auxiliary tool provided with a member.

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