JP2010148549A - Endoscope system and endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To appropriately dispose the insertion part of an auxiliary tool to the insertion part of a nasal endoscope at a position corresponding to treatment contents, and to quickly perform coping even when the treatment contents are changed during an inspection. <P>SOLUTION: The insertion part 16 of the endoscope includes an insertion part body composed of a distal end hard part, a curved part and a soft part, and an outer cylinder part 21 freely rotatably attached to the outer periphery of the insertion part body. On the outer surface of the outer cylinder part 21, magnets 80 and 82 are provided. On the outer surface of the insertion part 40 of the auxiliary tool, magnetic bodies 84 and 86 are provided. When the respective insertion parts 16 and 40 are arranged in parallel, the respective magnets 80 and 82 and the respective magnetic bodies 84 and 86 are magnetized, and the distal end of the insertion part 40 of the auxiliary tool 12 is fixed to the outer surface of the outer cylinder part 21. After fixing the insertion part 40, by rotating the outer cylinder part 21, the position of the insertion part 40 of the auxiliary tool to the insertion part body of the endoscope is freely changed. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscope system that uses a combination of 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. In addition, transnasal endoscopes allow mouth breathing, less anesthetics than oral endoscopy, and subjects can talk to surgeons during the examination. In recent years, demand has increased.

  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.

  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 forceps ducts and the like provided in the insertion section than oral endoscopes, and these diameters can be reduced or any of them can be deleted. There is a problem of having to.

  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, a nasal endoscope is provided by using an auxiliary tool having a forceps conduit, a light guide, and the like, and having an insertion portion having the same diameter as that of a transnasal endoscope. It is conceivable to assist the function of the mirror. 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. In this way, if an auxiliary tool is used in combination, a transnasal endoscope can perform the same level of treatment as an oral endoscope.

By the way, the position of the insertion part of the auxiliary tool with respect to the transnasal endoscope differs depending on the contents of the treatment. For example, when a treatment tool is inserted into each forceps conduit to perform a treatment (so-called double forceps), it is preferable to arrange the insertion portion of the auxiliary tool so that each treatment tool enters from both sides of the observation field. . In addition, when performing ESD (endoscopic submucosal dissection / peeling) using the forceps conduit of the auxiliary tool, the insertion part of the auxiliary tool is arranged so that the treatment tool enters from below the observation field of view. It is preferable. Further, when the forceps conduit of the auxiliary tool is used as the suction conduit, it is preferable to arrange the insertion portion of the auxiliary tool so that the opening of the forceps conduit is positioned below the observation field.
JP 2006-68030 A JP 2007-61377 A

  When using a combination of a nasal endoscope and an auxiliary tool, if each insertion part is separated, each must be operated individually, resulting in poor operability. For this reason, when performing a test combining both, after inserting each insertion portion from a separate nostril, treat the tip of each insertion portion within the body cavity of the subject (from the inner nostril to the esophagus) It is preferable to fix the position according to the content.

  However, when bleeding occurs due to treatment with a treatment tool, for example, there are cases where it is desired to change the content of the treatment during the examination, such as switching the forceps line to the suction line and sucking the blood that has been bleed. . In such a case, if each insertion part is fixed, each insertion part must be pulled out once and the fixing position of each insertion part must be adjusted, which is very troublesome and requires urgency such as bleeding In addition, there is a problem that it is impossible to respond quickly.

  The present invention has been made in view of the above problems, and when an inspection is performed by combining a nasal endoscope and an auxiliary tool, the insertion part of the auxiliary tool with respect to the insertion part of the nasal endoscope It is an object of the present invention to be able to appropriately arrange at a position corresponding to the treatment content, and to be able to respond quickly even when the treatment content changes during the examination.

  In order to achieve the above object, the present invention provides an endoscope having an insertion portion in which a forceps conduit for inserting a treatment instrument is formed, and a hand operation portion connected to a proximal end portion of the insertion portion. And an auxiliary tool having an insertion portion in which a forceps conduit having a diameter larger than the forceps conduit of the endoscope is formed, and inserting the insertion portion of the endoscope from one outer nostril, In an endoscope system in which an insertion part of an auxiliary tool is inserted from the other outer nostril and the function of the forceps conduit of the endoscope is supplemented by the auxiliary tool to perform an inspection, the insertion part of the endoscope is It is composed of an insertion portion main body in which a forceps conduit is formed and an outer cylindrical portion rotatably attached to the outer periphery of the insertion portion main body, and the distal end of the insertion portion of the auxiliary tool is fixed to the outer surface of the outer cylindrical portion. The fixing means is provided.

  It is preferable that the outer cylinder part is formed slightly longer than the insertion part main body, the front end is aligned with the front end of the insertion part main body, and the rear end is hooked on the hand operation part.

  It is preferable that the fixing means fixes the insertion portion of the auxiliary tool to the outer cylinder portion in a state where the distal ends of the insertion portions are aligned.

  It is preferable that the auxiliary tool has an attachment portion for detachably attaching the proximal end portion of the insertion portion to the hand operation portion.

  In addition to the forceps conduit, the auxiliary tool also illuminates illumination means for illuminating the inside of the body cavity, an air supply conduit for sending gas into the body cavity, and a liquid into the body cavity It is preferable to have at least one of the water supply pipelines.

  In addition, the present invention has an insertion portion in which a forceps conduit for inserting a treatment instrument is formed, the insertion portion is inserted from one outer nostril, and a forceps tube having a diameter larger than that of the forceps conduit In an endoscope in which an insertion portion of an auxiliary tool in which a path is formed is inserted from the other nostril and the function of the forceps conduit is supplemented by the auxiliary tool for inspection, the insertion portion is connected to the forceps conduit. A fixing means for fixing the distal end of the insertion portion of the auxiliary tool to the outer surface of the outer cylinder portion, the insertion portion main body being formed and an outer cylinder portion rotatably attached to the outer periphery of the insertion portion main body; It is provided.

  According to the present invention, after the distal end of the insertion part of the auxiliary tool is fixed to the outer surface of the outer cylinder part by the fixing means, the insertion part of the auxiliary tool is inserted into the insertion part of the endoscope by rotating the outer cylinder part. It can arrange | position appropriately with respect to the part main body in the position according to the treatment content. In addition, even when the treatment content changes during the examination, the change of the treatment content can be quickly handled by rotating the outer cylinder portion and changing the position of the insertion portion of the auxiliary tool with respect to the insertion portion main body.

  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 includes an insertion portion 16 that is inserted into the body cavity of the subject, a hand operation portion 17 that is connected to the proximal end portion of the insertion portion 16 and that is operated by an operator such as a doctor, It has a universal cable 18 connected to the hand operation unit 17 and for connecting the endoscope 11 to the light source device 13 and the processor device 14. In addition, a forceps conduit 57 (see FIG. 3) for inserting various treatment tools such as forceps and snare from the hand operating section 17 to the distal end of the insertion section 16 is provided inside the endoscope 11. Is provided. The insertion portion 16 is formed in a tubular shape having an outer diameter of about 6 mm. The forceps conduit 57 is formed in a tubular shape having an inner diameter of about 2 mm.

  The auxiliary tool 12 includes an insertion portion 40 to be inserted into the body cavity of the subject, and an attachment portion 41 for attaching the proximal end portion of the insertion portion 40 to the hand operation portion 17 of the endoscope 11. Yes. The insertion portion 40 is formed in a tubular shape having an outer diameter substantially the same as or slightly thinner than the insertion portion 16 of the endoscope 11. A forceps conduit 74 (see FIG. 5) having a diameter larger than that of the forceps conduit 57 of the endoscope 11 is provided inside the auxiliary tool 12 from the attachment portion 41 to the distal end of the insertion portion 40. Yes.

  The endoscope 11 is a so-called transnasal endoscope that inserts the insertion portion 16 from the outer nostril. In the endoscope 11, the diameter of the insertion portion 16 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 57 provided in the insertion portion 16 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 16 of the endoscope 11 from one outer nostril, and inserts the insertion portion 40 of the auxiliary tool 12 from the other outer nostril where the insertion portion 16 of the endoscope 11 is not inserted. Are used in combination. Further, by assisting the function of the forceps conduit 57 of the endoscope 11 with the forceps conduit 74 of the assisting tool 12, even when performing inspection with the endoscope 11 which is a transnasal endoscope, the oral endoscope is used. 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 pipe line of a general oral endoscope is about 3.2 mm, it is preferable that the internal diameter of the forceps pipe line 74 of the auxiliary tool 12 is 3.2 mm or more.

  As shown in FIG. 2, the insertion portion 16 of the endoscope 11 is rotatably attached to an insertion portion main body 20 configured in the same manner as a known endoscope insertion portion and the outer periphery of the insertion portion main body 20. And an outer cylinder portion 21. The insertion part main body 20 has the front-end | tip hard part 22, the bending part 23, and the soft part 24 in an order from the front-end | tip. The hard distal end portion 22 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 23 is configured to bend in four directions, up, down, left, and right in conjunction with operations of the up / down bending operation portion 25 and the left / right bending operation portion 26 provided in the hand operation portion 17. As a result, the inside of the body cavity can be observed with the distal end surface of the distal end rigid portion 22 facing the desired direction. The flexible portion 24 is a portion that connects the hand operating portion 17 and the bending portion 23, is formed in a thin and long tubular shape, and has flexibility.

  Note that the bending direction of the bending portion 23 is defined in accordance with the direction of the endoscopic image displayed on the monitor 15 (the direction of the image sensor or the observation optical system disposed in the distal end hard portion 22). When the up / down bending operation unit 25 is operated to instruct upward bending, the endoscopic image displayed on the monitor 15 moves upward. When the up / down bending operation unit 25 is operated to instruct downward bending, the endoscopic image displayed on the monitor 15 moves downward. When the right and left bending operation unit 26 is operated to instruct rightward bending, the endoscopic image displayed on the monitor 15 moves to the right. When the left / right bending operation unit 26 is operated to instruct leftward bending, the endoscopic image displayed on the monitor 15 moves leftward. Thus, the bending portion 23 is configured to bend in a direction corresponding to the display of the endoscopic image.

  The outer cylinder portion 21 is formed in a cylindrical shape having an inner diameter substantially the same as the outer diameter of the insertion portion main body 20. The outer cylinder portion 21 is made of a resin material and has flexibility. The distal end of the outer cylinder portion 21 is aligned with the distal end of the insertion portion main body 20. The outer cylinder portion 21 is formed slightly longer than the insertion portion main body 20. A taper portion 21 a corresponding to the shape of the hand operation portion 17 is formed at the rear end of the outer cylinder portion 21, and the taper portion 21 a is hooked on the hand operation portion 17. Thereby, the outer cylinder part 21 can be freely rotated with respect to the insertion part main body 20 by gripping and turning the taper part 21a.

  Returning to FIG. 1, in addition to the bending operation sections 25 and 26, the hand operation section 17 includes a forceps inlet 27 for inserting the treatment instrument into the forceps conduit 57, an observation window 62, and air or water in the body cavity. An air supply / water supply button 28 for performing air supply / water supply for feeding air, a suction button 29 for performing suction of air, residues, body fluids and the like accumulated in the body cavity, and liquids such as washing water and chemicals are to be observed. A water jet port (WJ port) 30 and the like are provided for injecting the water. A syringe is detachably connected to the WJ port 30. Washing water, chemicals, and the like that are sprayed onto the observation target are supplied from this syringe. Note that the forceps inlet 27 and the WJ port 30 are usually closed by a detachable stopper.

  The universal cable 18 includes a light guide connector (LG connector) 32 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 17. Connector) 33. The electrical connector 33 is connected to the LG connector 32 via a cord 34. The endoscope 11 is detachably connected to the devices 13 and 14 through these connectors 32 and 33.

  The LG connector 32 has a joint for connecting a water supply tank 35 for storing water for water supply and a joint for connecting a suction device 36 for supplying suction pressure for suction to the endoscope 11. And are provided. The LG connector 32 is connected to the water supply tank 35 via a water supply joint and a water supply tube 35a, and is connected to the suction device 36 via a suction joint and a suction tube 36a.

  The suction joint is connected to a suction pipe formed in the endoscope 11. This suction line is connected to the forceps line 57 in the hand operation unit 17 and is closed by a valve that is interlocked with the pressing operation of the suction button 29. When the suction button 29 is pressed, the suction line is opened, and the path from the forceps line 57 to the suction device 36 via the suction line and the suction tube 36a is connected. When this path is connected, suction is started by the suction pressure of the suction device 36, and air, body fluid, and the like accumulated in the body cavity are sucked from the distal end of the insertion portion 16. Further, when the suction device 36 sucks liquid such as washing water or body fluid, the liquid is stored in the suction tank 36b. As described above, the forceps conduit 57 also serves 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 32, and makes the illumination light incident on the light incident surface. Illumination light incident on the LG connector 32 is guided to the illumination optical system in the distal end hard portion 22 by a light guide provided in the endoscope 11, and an illumination window 63 disposed on the distal end surface of the distal end hard portion 22. 64 (see FIG. 4).

  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 32 and also to the water supply tube 35a.

  In the water supply tube 35a, air supplied from the light source device 13 is supplied to the water supply tank 35 to apply pressure to the water supply tank 35, and water in the water supply tank 35 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 32.

  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 28. In the center of the air / water supply button 28, 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 according to the pressing operation of the air / water supply button 28. When the hole of the air / water supply button 28 is closed with a finger, the air supplied from the light source device 13 is sent to the air supply pipe and discharged from the air / water supply nozzle 66 disposed at the distal end of the insertion portion 16. When the air / water supply button 28 is pressed, the air supply line is closed, the water supply line is opened, and the water delivered from the water supply tank 35 is discharged from the air / water supply nozzle 66.

  It should be noted that the air supply conduit and the water supply conduit of the endoscope 11 are combined into one as an air supply / water supply conduit 58 (see FIG. 3) at a portion downstream of the valve. In the insertion portion 16, the air from the light source device 13 and the water from the water supply tank 35 are sent to the distal end of the insertion portion 16 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 40 of the auxiliary tool 12 is composed of a tip part 42 and a flexible part 43. The distal end portion 42 is formed of a hard material such as metal, like the distal end rigid portion 22 of the endoscope 11. The flexible portion 43 is also configured in the same manner as the flexible portion 24 of the endoscope 11, is formed into a thin and long tubular shape, has flexibility, and includes a distal end portion 42 and an attachment portion 41. Connect between them.

  The attachment portion 41 is formed in a substantially T-shaped three-pronged tube and is connected to the insertion portion 40 via a central conduit. One end of the attachment portion 41 is formed to have an inner diameter substantially the same as the outer diameter of the forceps inlet 27 formed in a substantially cylindrical shape. The attachment portion 41 is detachably attached to the hand operation portion 17 by fitting this one end portion to the forceps inlet 27.

  The other end of the attachment portion 41 is a forceps inlet 44 for inserting a treatment instrument into the forceps conduit 57 of the endoscope 11 and the forceps conduit 74 of the auxiliary instrument 12. As described above, the auxiliary tool 12 is attached to the forceps inlet 27 of the endoscope 11 by the attachment portion 41, and then is endoscopically viewed through the forceps inlet 44 and the internal conduit of the attachment portion 41 formed in a trifurcated tube. The treatment instrument can be selectively inserted into the forceps conduit 57 of the mirror 11 and the forceps conduit 74 of the auxiliary instrument 12. The forceps inlet 44 is formed in substantially the same shape as the forceps inlet 27 of the endoscope 11. Thereby, the forceps stopper used for the forceps inlet 27 of the endoscope 11 can be attached to the forceps inlet 44.

  As described above, the forceps conduit 57 of the endoscope 11 also has a function as a suction conduit. When the auxiliary tool 12 is attached to the forceps inlet 27 and the suction button 29 is pressed, the forceps conduit 57 of the endoscope 11 and the forceps conduit 74 of the auxiliary tool 12 are attached via the attachment part 41 formed in a trifurcated tube. Are connected to each other from the forceps conduits 57 and 74 at the same time. Thereby, when suction is performed using the auxiliary tool 12 in combination, the amount of suction per unit time can be increased.

  In addition, as timing which attaches the attachment part 41 of the auxiliary tool 12 to the forceps inlet 27, it can be considered before each insertion part 16 and 40 is inserted into the body cavity and after the insertion. At this time, in the latter case, it is desirable that the length of the insertion portion 40 of the auxiliary tool 12 be longer than that of the insertion portion 16 of the endoscope 11 because the operation is easy.

  As shown in FIG. 3, the flexible portion 24 of the endoscope 11 includes a screw tube 50 called a flex that protects the inside while maintaining flexibility in order from the inside, and the outer layer 52 of the outer layer 52 that is covered on the screw tube 50. It is composed of a flexible tube 53 consisting of three layers of a net 51 called a blade for holding a resin and an outer layer 52 on which the resin is deposited on the net 51.

  Inside the flexible tube 53, there are light guides 54, 55, an angle wire 56, a forceps conduit 57, an air / water supply conduit 58, a multicore cable 59, and a water jet conduit (WJ conduit) 60. Etc. are provided. The light guides 54 and 55 guide the illumination light supplied from the light source device 13 to the illumination optical system of the distal end hard portion 22. The angle wire 56 is configured such that two angle wires for up and down and left and right are respectively wound around two pulleys interlocking with the operations of the bending operation portions 25 and 26 and their tips are inserted toward the bending portion 23. Therefore, there are four inside the flexible tube 53, and each of them is inserted into the tight coil pipe 56a.

  The forceps conduit 57 guides the treatment instrument inserted from the forceps inlet 27 or the forceps inlet 44 to the distal rigid portion 22. The air / water supply conduit 58 sends air or water supplied in response to a press operation of the air / water supply button 28 to the hard tip portion 22. The multi-core cable 59 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 60 sends liquid such as water and chemicals supplied from the syringe connected to the WJ port 30 to the distal end hard portion 22.

  As shown in FIG. 4, an observation window 62, a pair of illumination windows 63 and 64, a forceps outlet 65, an air / water supply nozzle 66, and a water jet nozzle are provided on the distal end surface 22 a of the distal end rigid portion 22 of the endoscope 11. (WJ nozzle) 67 and the like are provided. In the observation window 62, a part of an observation optical system for taking in image light from the observation object is arranged. The illumination windows 63 and 64 are provided on both sides of the observation window 62 and irradiate light from the light source device 13 supplied via the light guides 54 and 55 toward the observation target.

  The forceps outlet 65 leads the distal end of the treatment instrument inserted into the forceps conduit 57. The air supply / water supply nozzle 66 injects air and water sent from the air supply / water supply conduit 58 in response to the pressing operation of the air supply / water supply button 28. The injection port of the air / water supply nozzle 66 is formed so that the air and water to be injected are directed to the observation window 62. As a result, the observation window 62 is washed with the air or water jetted from the air / water feed nozzle 66, and dirt and the like adhering to the observation window 62 can be washed away. The WJ nozzle 67 ejects a liquid such as cleaning water or a chemical liquid sent from the WJ pipe line 60. The ejection port of the WJ nozzle 67 is formed in the direction of the optical axis of the observation window 62, and directly sprays the liquid to be ejected onto the observation target.

  As shown in FIG. 5, the flexible portion 43 of the assisting tool 12 is covered with a flexible tube 73 composed of three layers of a screw tube 70, a net 71, and an outer layer 72, similarly to the flexible portion 24 of the endoscope 11. It has been broken. The screw tube 70 protects the inside while maintaining flexibility. The net 71 is covered on the screw tube 70 and holds the resin of the outer layer 72. The outer layer 72 is obtained by depositing a resin on the net 71.

  In the flexible tube 73, a forceps conduit 74 made of a synthetic resin flexible tube is provided. The forceps conduit 74 guides the treatment instrument inserted from the forceps inlet 44 to the distal end portion 42. Further, as shown in FIG. 6, a forceps outlet 76 for leading the distal end of the treatment instrument inserted into the forceps conduit 74 is formed on the distal end surface 42 a of the distal end portion 42.

  As shown in FIG. 7, the insertion portion 16 of the endoscope 11 is provided with two magnets (fixing means) 80 and 82 formed in a rectangular shape on the outer surface of the outer cylinder portion 21. Each of the magnets 80 and 82 is bent according to the curvature of the outer surface of the outer cylinder part 21 and is attached so as to be embedded in the outer cylinder part 21, and is substantially flush with the outer surface of the outer cylinder part 21. . Further, the magnets 80 and 82 are arranged so as to be aligned in a straight line in the axial direction of the insertion portion 16 and located near both ends of the bending portion 23.

  On the other hand, the insertion part 40 of the auxiliary tool 12 is provided with two magnetic bodies 84 and 86 formed in a ring shape on the outer surface of the soft part 43 as shown in FIG. Each of these magnetic bodies 84 and 86 is made of, for example, iron and has a property of being magnetically attached to a magnet. Each of the magnetic bodies 84 and 86 is attached so as to be embedded in the soft part 43, and is substantially flush with the outer surface of the soft part 43. The widths of the magnetic bodies 84 and 86 are substantially the same as the widths of the magnets 80 and 82.

  As shown in FIG. 8 (a), the magnetic bodies 84 and 86 face the magnets 80 and 82 when the distal end surfaces 22a and 42a are aligned and the insertion portions 16 and 40 are arranged in parallel. Are arranged respectively. As a result, when the distal end surfaces 22a and 42a are aligned and the insertion portions 16 and 40 are arranged in parallel, the magnets 80 and 82 and the magnetic bodies 84 and 86 are magnetized as shown in FIG. The distal end of the insertion portion 40 of the auxiliary tool 12 is fixed to the outer surface of the outer cylinder portion 21 with the distal ends of the insertion portions 16 and 40 aligned.

  If the distal end of the insertion portion 40 is fixed to the outer surface of the outer cylinder portion 21 in this way, the flexible portion 43 of the insertion portion 40 bends following the bending of the bending portion 23 accompanying the bending operation of each bending operation portion 25, 26. Then, the distal end surface 22a of the endoscope 11 and the distal end surface 42a 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. Further, the outer cylinder portion 21 freely rotates with respect to the insertion portion main body 20. Thereby, after fixing the front-end | tip of the insertion part 40 to the outer surface of the outer cylinder part 21, the position of the insertion part 40 of the auxiliary tool 12 with respect to the insertion part main body 20 of the endoscope 11 is rotated by rotating the outer cylinder part 21. It can be changed freely.

  The position of the insertion portion 40 with respect to the insertion portion main body 20 varies depending on the content of the treatment performed when the endoscope 11 and the auxiliary tool 12 are used in combination. For example, when performing ESD by inserting a high-frequency knife or the like into the forceps conduit 74 of the auxiliary tool 12, the insertion portion 40 is disposed below the observation window 62 as shown in FIG. Here, “down” is a direction in which the bending portion 23 bends when the up / down bending operation portion 25 is operated to instruct a downward bending.

  As described above, the bending direction of the bending portion 23 is defined according to the direction of the endoscopic image displayed on the monitor 15. Therefore, when the insertion portion 40 is arranged as shown in FIG. 9, the high-frequency knife 92 enters the observation field from the lower side of the endoscope image 90 as shown in FIG. In this way, the mucosa to be incised and the high-frequency knife 92 can be observed from above, and the insertion portion 16 of the endoscope 11 does not get in the way when the high-frequency knife 92 is moved left and right to incise the mucosa. So it is easy to treat.

  Further, when a treatment tool is inserted into each of the forceps conduit 57 of the endoscope 11 and the forceps conduit 74 of the auxiliary tool 12 to perform the treatment, as shown in FIG. The insertion portion 40 is disposed on the right side in the bending direction. When the insertion portion 40 is arranged in this manner, as shown in FIG. 12, the forceps 94 led out from the forceps outlet 65 of the endoscope 11 and the forceps 96 led out from the forceps outlet 76 of the auxiliary tool 12 are Since it enters into an observation visual field from both sides of the endoscopic image 90, each forceps 94 and 96 becomes easy to operate.

  Note that when the treatment tools 94 and 96 are inserted into the forceps conduits 57 and 74 as described above, the attachment portion 41 is not attached to the forceps inlet 27, and the forceps 94 and 96 are inserted from both the forceps inlets 27 and 44. Insert.

  One of the types of endoscopes currently on the market is a so-called large forceps treatment endoscope having a forceps conduit having an inner diameter of about 3.8 mm. Such an endoscope for large forceps treatment is in the bending direction left side with respect to the observation window (the direction in which the bending portion 23 is bent when the left / right bending operation unit 26 is instructed to bend leftward). A forceps conduit is disposed.

  Therefore, when a large forceps treatment is performed using the forceps conduit 74 of the auxiliary tool 12, the insertion portion 40 is disposed on the left side in the bending direction with respect to the observation window 62 as shown in FIG. By doing so, it is possible to perform the operation without giving a sense of incongruity to the operator who is accustomed to the operation of the endoscope for existing large forceps treatment.

  Further, when suction is performed using only the forceps conduit 74 of the auxiliary tool 12, the insertion part 40 of the auxiliary tool 12 is disposed below the insertion part 16 of the endoscope 11 (see FIG. 9). In this way, the forceps outlet 76 of the insertion portion 40 can be brought close to the washing water or body fluid accumulated in the body cavity while observing with the endoscope 11 without the insertion portion 16 of the endoscope 11 getting in the way. it can. Therefore, by arranging the insertion portion 40 as described above, the suction by the forceps conduit 74 of the auxiliary tool 12 can be efficiently performed.

  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 part 16 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 16 can be inserted is determined. The pretreatment is performed in the sitting position or the supine position, and thereafter, the insertion portion 16 is inserted into one outer nostril in the supine position or the left-side supine position. After being inserted from the outer nostril, the insertion unit 16 reaches the stomach or duodenum via the middle or lower nasal passage, the rear nostril (inner nostril), and the esophagus.

  When it is determined that treatment or treatment is not necessary by observing the duodenum or stomach, the insertion portion 16 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 57 of the endoscope 11, a treatment such as a small snare or a biological forceps can be performed using the forceps conduit 57. A device is inserted for treatment or therapy.

  When it is determined that treatment or therapy cannot be performed in the forceps conduit 57 of the endoscope 11, the auxiliary tool 12 is used together. When the auxiliary tool 12 is used in combination with the endoscope 11, first, the insertion part 40 of the auxiliary tool 12 is inserted into the other nostril, so that the nasal cavity of the other nostril is anesthetized. Next, in order to fix the distal end of the insertion portion 40 of the auxiliary tool 12 to the distal end of the insertion portion 16 of the endoscope 11, the endoscope 11 is arranged so that the distal end surface 22 a is located in the range from the rear nostril to the esophagus. The insertion part 16 is pulled back. Then, the insertion part 40 of the auxiliary tool 12 is inserted from the other outer nostril, and the distal end surface 42a is positioned in the range from the rear nostril to the esophagus.

  After the insertion portions 16 and 40 are inserted, the magnets 80 and 82 and the magnetic bodies 84 and 86 are magnetized, and the insertion portions 40 of the auxiliary tool 12 are aligned with the tips of the insertion portions 16 and 40 aligned. The tip is fixed to the outer surface of the outer cylinder part 21. When the insertion portion 40 is fixed to the outer cylinder portion 21, the hand operating portion 17 and the taper portion 21a are gripped and the outer cylinder portion 21 is rotated to assist the insertion portion main body 20 of the insertion portion 16 of the endoscope 11. The insertion part 40 of the instrument 12 is arranged at a position corresponding to the treatment content. Thus, in the endoscope system 10, the insertion portion 40 can be appropriately disposed at a position corresponding to the treatment content with respect to the insertion portion main body 20 by rotating the outer cylinder portion 21.

  After the insertion portion 40 is arranged at a position corresponding to the treatment content, the attachment portion 41 of the auxiliary tool 12 is attached to the forceps inlet 27 of the endoscope 11 and insertion of the insertion portions 16 and 40 is started. When inserting each insertion part 16 and 40, each bending operation part 25 and 26 is operated while looking at the screen of the monitor 15, and insertion is performed while the bending part 23 of the endoscope 11 is bent. At this time, the flexible portion 43 of the auxiliary tool 12 is in close contact with the bending portion 23 of the endoscope 11 by the magnetic adhesion between the magnets 80 and 82 and the magnetic bodies 84 and 86, so that the bending of the endoscope 11 is performed. It curves together with the part 23. Further, it is inserted following the insertion of the insertion portion 16 of the endoscope 11. Thereby, the insertion part 40 of the auxiliary tool 12 is also inserted together only by holding the insertion part 16 of the endoscope 11.

  When each of the insertion parts 16 and 40 is inserted and an affected part 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 inserted into a forceps inlet provided in the attachment part 41. 44 to the forceps conduit 74 of the auxiliary tool 12. Then, the distal treatment member of the treatment tool, for example, a pair of forceps cups or a strangulation loop is led out from the forceps outlet 76 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 strangulation loop formed by bending an elastic wire enters and exits from the sheath tip by operation from the proximal side of 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 part of the polyp is properly tightened with a strut loop, and then a high-frequency current is applied to the strut loop to make contact with the strut 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 biopsy forceps is used by using the forceps conduit 74 of the auxiliary tool 12, for example, tissue collection (biopsy) to remove the tissue, removal of foreign matter, bleeding stop, tumor removal, gallstone removal Treatment and treatment such as crushing. Further, when it is desired to aspirate internal dirt or blood or other body fluids, when the suction button 29 of the hand operation unit 17 is pressed, suction is performed not only from the forceps outlet 65 of the endoscope 11 but also from the forceps outlet 76 of the auxiliary tool 12. Therefore, rapid suction can be performed, and since suction from both forceps outlets 65 and 76 can be performed simultaneously, a large amount of living tissue can be collected.

  As described above, when the treatment content changes during the treatment using the forceps conduit 74 of the auxiliary tool 12, the outer cylinder portion 21 is rotated again to a position corresponding to the treatment content after the change. The insertion part 40 of the auxiliary tool 12 is arranged.

  For example, when the insertion portion 40 is disposed on the left side in the bending direction with respect to the observation window 62 (see FIG. 13) and the insertion portion 40 is used for large forceps, bleeding may occur unexpectedly. . In such a case, the treatment tool is pulled out from the forceps conduit 74, the outer cylinder portion 21 is rotated, and the insertion portion 40 of the auxiliary tool 12 is disposed below the insertion portion 16 of the endoscope 11 (see FIG. 9). In this way, while confirming the bleeding site with the endoscope 11, the bleeding blood is efficiently sucked using the forceps conduit 74 of the auxiliary tool 12 having a larger suction amount than the forceps conduit 57 of the endoscope 11. can do. As described above, in the endoscope system 10, by rotating the outer cylinder portion 21 and changing the position of the insertion portion 40, it is possible to quickly cope with a change in treatment content during an examination.

  After the treatment or treatment is completed, the treatment tool is pulled out from the forceps inlet 44 of the auxiliary tool 12, and then both the insertion portions 16 and 40 are slowly pulled out. In the middle of this, for example, before passing through the range from the posterior nostril to the esophagus, the fixation of the distal ends of both insertion portions 16 and 40 is released. The release of the fixing is performed, for example, by forcibly pulling the other one of the insertion portions 16 and 40 and releasing the magnetic attachment between the magnets 80 and 82 and the magnetic bodies 84 and 86. After the fixing of the insertion portions 16 and 40 is released, the insertion portions 16 and 40 are individually pulled out in the order of the auxiliary tool 12 and the endoscope 11. Finally, the attachment part 41 of the auxiliary tool 12 is removed from the forceps inlet 27 of the hand operation part 17.

  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 57 of the endoscope 11, the assisting tool 12 may be used from the beginning.

  In the above embodiment, the outer cylinder portion 21 is formed slightly longer than the insertion portion main body 20, but the length of the outer cylinder portion 21 is not limited to this, and may be the same as the insertion portion main body 20. The insertion portion main body 20 may be slightly shorter. That is, the length of the outer cylinder part 21 is such that when the insertion part 16 is inserted into the body cavity, the vicinity of the rear end is exposed outside the body cavity and the outer cylinder part 21 can be rotated from outside the body cavity. If it is.

  However, if the outer cylinder portion 21 is formed slightly longer than the insertion portion main body 20 and the rear end is hung on the hand operation portion 17 as described above, the rigid hand operation portion 17 is gripped. Thus, since the outer cylinder portion 21 can be rotated, the rotation operation of the outer cylinder portion 21 can be facilitated.

  In the above embodiment, the magnets 80 and 82 are provided in the insertion portion 16 of the endoscope 11 and the magnetic bodies 84 and 86 are provided in the insertion portion 40 of the auxiliary tool 12. A magnetic body may be provided, and a magnet may be provided in the insertion portion 40, or both may be magnets. The magnets 80 and 82 are not limited to permanent magnets, and may be electromagnets.

  Moreover, in the said embodiment, although each magnet 80 and 82 was shown as a fixing means, a fixing means can fix the front-end | tip of the insertion part 40 of the auxiliary tool 12 to the outer surface of the outer cylinder part 21 without being restricted to this. Anything can be used.

  In the above embodiment, the forceps conduit 74 is provided in the auxiliary tool 12 to assist the function of the forceps conduit 57 of the endoscope 11. However, the present invention is not limited to this. For example, a light guide is provided in the auxiliary tool 12. It may be provided to assist the functions of the light guides 54 and 55 of the endoscope 11, or the air supply / water supply conduit 58 of the endoscope 11 may be provided by providing the auxiliary tool 12 with the air / water supply conduit 58. May be provided, or a WJ pipe line may be provided in the auxiliary tool 12 to assist the function of the WJ pipe line 60 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 54 and 55 and the air / water supply conduit 58 are narrower than those of the oral endoscope as in the forceps conduit 57. Many transnasal endoscopes do not include the WJ duct 60 and the WJ nozzle 67. Reducing the diameters of the light guides 54 and 55 causes a decrease in the amount of illumination light and light distribution characteristics, and the distant view becomes dark. In addition, the reduction in the diameter of the air / water supply conduit 58 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 60 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 pipe, the liquid can be ejected as a water jet as in the case of the oral endoscope.

  In the above embodiment, the proximal end portion of the insertion portion 40 is detachably attached to the hand operation portion 17 of the endoscope 11 via the attachment portion 41. However, the present invention is not limited thereto, and the proximal end portion of the insertion portion is not limited thereto. It is good also as a structure which does not attach a part.

It is explanatory drawing which shows the structure of an endoscope system roughly. It is explanatory drawing which shows schematically the structure of the insertion part of an endoscope. It is sectional drawing which shows schematically the structure in the soft part of an endoscope. It is a top view which shows roughly 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 a top view which shows roughly the structure of the front end surface of the insertion part of an auxiliary tool. It is a fragmentary perspective view which shows roughly the structure of the front-end | tip of the insertion part of an endoscope. It is explanatory drawing which shows the state by which each insertion part was fixed. It is explanatory drawing which shows the example which has arrange | positioned the insertion part of the auxiliary tool under the observation window. It is an example of the endoscopic image at the time of performing ESD. It is explanatory drawing which shows the example which has arrange | positioned the insertion part to the bending direction right side with respect to the observation window. It is an example of the endoscopic image at the time of performing a treatment with double forceps. It is explanatory drawing which shows the example which has arrange | positioned the insertion part to the bending direction left side with respect to the observation window. 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 16 Insertion part 17 Hand operation part 20 Insertion part main body 21 Outer cylinder part 40 Insertion part 41 Attachment part 57 Forceps conduit 74 Forceps conduit 80, 82 Magnet (fixing means)

Claims (6)

An endoscope having an insertion portion in which a forceps conduit for inserting the treatment tool is formed, and a hand operation portion connected to the proximal end portion of the insertion portion;
An auxiliary tool having an insertion portion in which a forceps conduit having a diameter larger than the forceps conduit of the endoscope is formed,
The insertion part of the endoscope is inserted from one outer nostril, the insertion part of the auxiliary tool is inserted from the other outer nostril, and the function of the forceps conduit of the endoscope is supplemented by the auxiliary tool. In an endoscope system that performs
The insertion portion of the endoscope is composed of an insertion portion main body in which the forceps conduit is formed and an outer cylinder portion that is rotatably attached to the outer periphery of the insertion portion main body.
An endoscope system comprising a fixing means for fixing a distal end of an insertion portion of the auxiliary tool to an outer surface of the outer cylinder portion.   The outer cylinder part is formed slightly longer than the insertion part main body, and the front end is aligned with the front end of the insertion part main body, and the rear end is hooked on the hand operation part. The described endoscope system.   The endoscope system according to claim 1 or 2, wherein the fixing means fixes the insertion portion of the auxiliary tool to the outer cylinder portion in a state where the distal ends of the insertion portions are aligned.   The said auxiliary tool has an attaching part for attaching the base end part of the said insertion part to the said operation part detachably, The inside of any one of Claim 1 to 3 characterized by the above-mentioned. Endoscopic system.   In addition to the forceps conduit, the auxiliary tool is illumination means for illuminating the inside of the body cavity by illuminating illumination light, an air supply conduit for sending gas into the body cavity, and a liquid for sending liquid into the body cavity The endoscope system according to any one of claims 1 to 4, wherein the endoscope system includes at least one of water supply pipelines. An auxiliary device in which a forceps conduit for inserting the treatment instrument is formed, the insertion portion is inserted from one outer nostril, and a forceps conduit having a diameter larger than that of the forceps conduit is formed In an endoscope in which an insertion part of a tool is inserted from the other nostril and the function of the forceps conduit is supplemented by the auxiliary tool to perform an inspection,
The insertion portion is composed of an insertion portion main body in which the forceps conduit is formed, and an outer cylinder portion rotatably attached to the outer periphery of the insertion portion main body.
An endoscope comprising a fixing means for fixing a distal end of an insertion portion of the auxiliary tool to an outer surface of the outer cylinder portion.

Images