JP2010207340A - Endoscope guiding tube device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope guiding tube device which passively changes a shape in accordance with change of shape of an insertion part of a flexible endoscope, can be stably hold the shape, can be easily inserted through a mouth together with an insertion part of a soft endoscope by thinning easily, and can compose operation part so that it may operate compactly and certainly. <P>SOLUTION: A curved part 3 provided for the flexible insertion tube 1 passively freely changes its shape corresponding to shape change of an insertion part of an endoscope put through in the flexible insertion tube 1. A wire lock mechanism in which an operation part 2 includes proximal end parts of all of at least three curved shape holding wires 15 in such a way that they are altogether freely fixed or their fixation is freely cancelable presses a wire pressing member 31 in which a cylindrical body is divided into a plurality in a twisting direction around the axis to the proximal end parts of the curved shape holding wires 15 with a pressing drive member 32 slid and engaged on a slope. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscope guide tube that is inserted into a body cavity together with an insertion portion of a flexible endoscope and thereafter functions to keep the posture and orientation of the insertion portion of the flexible endoscope in a stable state. Relates to the device.

  Intraabdominal surgery such as cholecystectomy was previously performed by so-called laparotomy in which the abdomen is incised, but recently, several holes of about a few centimeters are made in the abdomen, and then a rigid endoscope Laparoscopic surgery in which treatment is performed by inserting a laparoscope, a surgical treatment tool, or the like is widely performed. However, even in such a laparoscopic operation, it takes a certain amount of time for the patient who has undergone the operation to recover, and even though it is small, a wound remains on the patient's body surface.

  Therefore, a flexible endoscope is inserted into the stomach through the mouth, and a hole is made in the stomach wall with a treatment instrument passed through the treatment instrument insertion channel of the flexible endoscope, and then transendoscopically ( That is, a technique for performing intra-abdominal surgery (through a treatment instrument insertion channel of an endoscope) has attracted attention. The hole made in the stomach wall is closed with an endoscopic clip after the operation is completed.

  However, it is difficult for the insertion portion of the flexible endoscope to stabilize the posture and orientation of the tip for a long time during the operation, and the posture and orientation of the insertion portion tip during the operation are contrary to the operator's will. If changed, transendoscopic abdominal surgery cannot be performed smoothly.

  Therefore, a flexible tubular body that can be inserted through the insertion portion of the flexible endoscope and passively changes its shape in response to a change in shape of the insertion portion of the flexible endoscope, and the tubular body It is conceivable to use an endoscope guide tube device provided with a shape holding means for holding the shape in combination with a flexible endoscope.

  Such an endoscope guide tube device for a flexible endoscope has not been devised so far for the purpose of transendoscopic abdominal surgery, Several insertion aids for insertion into the large intestine have been devised (for example, Patent Documents 1 and 2).

Special table 2006-512935 JP 2005-318956 A

  In the conventional endoscope guide tube devices described in Patent Documents 1 and 2, etc., the framework of the flexible insertion tube in which the endoscope guide channel is inserted and arranged near the axial position has a through hole in the center. It is configured by superposing a large number of bowl-shaped joints in series, and by pulling a wire or a mesh tube arranged around the joint to the base end side and applying a frictional resistance between the joints, The bent shape can be maintained.

  However, in such a configuration, a traction mechanism for strongly pulling a wire, a mesh tube, etc. to the proximal end side is necessary, so that the configuration becomes sturdy, heavy and large, and between a large number of joints. Since the shape is held by frictional resistance, slippage may occur between the joints due to the action of some external force, and the holding shape may change, and sufficient frictional force is obtained while ensuring the diameter of the guide pipe line. For this purpose, the outer diameter of the bowl-shaped joint must be increased in order to increase the contact area, so that it is extremely difficult to apply to a device inserted into the body through the mouth.

  According to the present invention, the shape of the insertion portion of the flexible endoscope can be passively changed in response to the change in shape, and the shape can be stably held. It is an object of the present invention to provide an endoscope guide tube device that can be easily inserted from a mouth together with an insertion portion of a mirror, and that an operation portion can be configured to operate in a compact and reliable manner.

  In order to achieve the above object, an endoscope guide tube device according to the present invention has a flexible endoscope guide tube that can be inserted through a insertion portion of a flexible endoscope and can be inserted into and removed from a body cavity. An endoscope guide tube device having a structure inserted and arranged in a flexible insertion tube, wherein a plurality of short cylindrical joint rings are adjacent to the entire flexible insertion tube or a portion near the tip. A bending portion having a framework that is connected in series with a connecting shaft so as to be rotatable relative to a joint ring that is configured to be bent in all directions as a whole is provided, and the bending portion is an endoscope guide tube The shape of the flexible endoscope inserted through the path is passively changeable in response to the shape change of the insertion portion, and the tips of at least three curved shape holding wires for holding the shape are provided. The operation portion connected to the distal end portion of the bending portion and disposed on the proximal end side of the flexible insertion tube has a curved shape holding wire. There is no operating means for pushing and pulling, the proximal end portions of the plurality of curved shape holding wires are arranged so as to be movable forward and backward in the axial direction, and the proximal end portions of all the curved shape holding wires are fixed together and An unlockable wire lock mechanism is provided, and the wire lock mechanism is a region in which the cylindrical body is divided into a plurality of directions twisted around the axis and the proximal end portions of the plurality of curved shape holding wires advance and retreat in the axial direction. And a wire pressing member that is movably disposed in a direction to be pressed / separated with respect to the proximal end portion of each curved shape holding wire, and is slidable along the longitudinal direction with respect to the wire pressing member A pressing drive member that is provided in engagement and that drives the wire pressing member in a direction to press / separate the proximal end portion of each curved shape holding wire by sliding with respect to the wire pressing member; An operation member for performing an operation of moving the pressure driving member in a direction in which the wire pressing member is slid with respect to the wire pressing member, and a slide engagement portion between the wire pressing member and the pressing driving member is disposed on the wire pressing surface of the wire pressing member. Thus, the wire pressing member is pressed / separated with respect to the proximal end portion of the curved shape holding wire by the sliding operation of the pressing drive member.

  Note that the wire pressing member may be configured by dividing the cylindrical body into a number (at least three) smaller than the number of curved shape holding wires, and the wire pressing member is formed of three divided pieces of the same shape. In addition, each divided piece may be twisted by 60 ° at both ends in the longitudinal direction.

  In addition, the wire pressing member and the pressing driving member engage with each other in a state where the sliding engagement portion is relatively slidable in the longitudinal direction of the wire pressing member and the relative movement is restricted in a different direction. It may be.

  The number of pressing drive members may be the same as the number of divided pieces of the wire pressing member so as to be slidably engaged with each of the divided pieces of the wire pressing member, and the operation member is rotated manually. You may provide the operation ring and the operation | movement conversion mechanism which converts the rotation operation of a rotation operation ring into a slide operation | movement, and transmits to a press drive member.

  Further, the at least three curved shape holding wires may be arranged at intervals between each other in a positional relationship in which there is no gap of 180 ° or more around the axis of the bending portion. Further, it may be inserted into a flexible guide pipe whose tip is fixed to the inner peripheral portion in the vicinity of the rear end of the curved portion so as to be movable forward and backward in the axial direction.

  In that case, the guide pipe may be a coil pipe formed by tightly winding a metal wire with a constant diameter, and the proximal end portion of the guide pipe is attached to the wire receiving surface together with the curved shape holding wire by the wire pressing mechanism. It may be fixed / released by pressing. Further, the proximal end portion of the guide pipe may be fixed to the operation portion.

  In addition, most of the endoscope guide conduit may be formed of a flexible tube that is inserted and disposed near the axial position of the flexible insertion tube. May be coated.

  In addition, a plurality of bending portions are connected in series, and the wire lock mechanism can freely fix and release the proximal end portions of all the curved shape holding wires connected to the distal end portions of the plurality of bending portions. It may be.

  And when the bending part is provided in the part near the front-end | tip of a flexible insertion tube, parts other than the bending part of a flexible insertion tube are penetrated in the endoscope guide conduit. It may be a flexible tube portion that is passively changeable in shape corresponding to the shape change of the insertion portion of the endoscope and has no shape retention.

  According to the present invention, the bending portion provided in the flexible insertion tube so as to be bent is passively adapted to the shape change of the insertion portion of the flexible endoscope that is passed through the flexible insertion tube. The shape can be changed and the shape can be stably held, and the curved portion is composed of a plurality of short cylindrical joint rings. Can be easily inserted.

  In addition, it is only necessary to provide a mechanism (wire lock mechanism) that does not need to pull the curved shape holding wire and simply locks the wire, and the wire lock mechanism is divided into a plurality of directions in which the cylindrical body is twisted around the axis. By adopting a configuration in which the wire pressing member is pressed against the proximal end portion of the curved shape holding wire with a pressing drive member that is slidably engaged on the inclined surface, the operation unit can be configured compactly and operated reliably. There are exceptional effects such as.

It is a side view which shows the whole structure of the endoscope guide tube apparatus of the Example of this invention. It is side surface sectional drawing of the flexible insertion tube of the endoscope guide tube apparatus of the Example of this invention. It is a side surface fragmentary sectional view of the endoscope guide channel of the endoscope guide tube apparatus of the Example of this invention. It is a single-piece | unit perspective view of the state in which the framework of the bending part of the endoscope guide tube apparatus of the Example of this invention was bent. It is VV sectional drawing in FIG. 2 of the endoscope guide tube apparatus of the Example of this invention. It is VI-VI sectional drawing in FIG. 2 of the endoscope guide tube apparatus of the Example of this invention. It is VII-VII sectional drawing in FIG. 2 of the endoscope guide tube apparatus of the Example of this invention. It is VIII-VIII sectional drawing in FIG. 2 of the endoscope guide tube apparatus of the Example of this invention. It is side surface sectional drawing of the operation part of the endoscope guide tube apparatus of the Example of this invention. It is XX sectional drawing in FIG. 9 of the endoscope guide tube apparatus of the Example of this invention. It is XI-XI sectional drawing in FIG. 9 of the endoscope guide tube apparatus of the Example of this invention. It is a partial exploded perspective view of the operation part of the endoscope guide tube apparatus of the Example of this invention. It is a partial exploded perspective view of the operation part of the endoscope guide tube apparatus of the Example of this invention. It is side surface sectional drawing of the operation part of the curved shape maintenance state of the endoscope guide tube apparatus of the Example of this invention. It is XV-XV sectional drawing in FIG. 13 of the endoscope guide tube apparatus of the Example of this invention. It is XVI-XVI sectional drawing in FIG. 13 of the endoscope guide tube apparatus of the Example of this invention. It is a schematic diagram which shows an example of the use condition of the endoscope guide tube apparatus of the Example of this invention.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 shows an overall configuration of an endoscope guide tube apparatus according to an embodiment of the present invention. The endoscope guide tube apparatus is flexible so that it can be bent in any direction and can be inserted into and removed from a body cavity as a whole. The insertion tube 1 and the operation unit 2 connected to the proximal end of the flexible insertion tube 1 are configured.

  The connecting portion between the base end of the flexible insertion tube 1 and the operation portion 2 has a tapered tapered cylindrical shape in order to prevent the vicinity of the base end of the flexible insertion tube 1 from being bent suddenly and buckled. A crease stopper 3 made of an elastic rubber material or the like formed on is attached.

  A state near the tip of the flexible insertion tube 1 is a state in which a first bending portion 11, a second bending portion 12, and a third bending portion 13, which can be bent in any direction, are connected in series. The portion near the base end of the flexible insertion tube 1 is a flexible tube portion 14 that can be bent in any direction.

  The difference between each bending portion 11, 12, 13 and the flexible tube portion 14 is that each bending portion 11, 12, 13 holds a bent shape by operation of the rotary operation ring 5 disposed in the operation portion 2. However, the flexible tube portion 14 cannot maintain a bent shape, which will be described later in detail.

  It should be noted that the flexible tube portion 14 is not necessarily provided depending on the use or procedure of the endoscope guide tube device. In that case, the entire flexible insertion tube 1 becomes a curved portion. In addition, the number of connecting portions of the bending portion can be selected as appropriate according to the use or technique of the endoscope guide tube device, such as only one or a plurality other than three, and the plurality of bending portions 11, 12, There may be a short flexible tube portion 14 or a hard portion between 13.

  In the flexible insertion tube 1, a flexible endoscope guide conduit 4 that can be inserted through an insertion portion of a flexible endoscope (not shown) is disposed in the vicinity of the axial position over the entire length. The proximal end opening 4a of the endoscope guide conduit 4 is disposed on the rear end surface of the operation unit 2, and the endoscope guide conduit is provided on the distal end face of the distal end cap 10 provided at the foremost end of the flexible insertion tube 1. Four tip openings 4b are arranged.

  As a result, an insertion portion (not shown) of the flexible endoscope is inserted into the endoscope guide duct 4 from the proximal end opening 4a, and the distal end portion of the insertion portion is arbitrarily moved forward from the distal end opening 4b. Can be plunged.

  FIG. 2 shows the configuration of the flexible insertion tube 1. The distal end cap 10 is formed in a substantially cylindrical shape by a metal or a hard plastic material or the like and is connected to the distal end portion of the first bending portion 11 to form most of the endoscope guide conduit 4, for example, tetrafluoride. A distal end portion of a flexible tube made of an ethylene resin tube or the like is bonded and fixed to the distal end cap 10 in a watertight manner from the rear. The flexible tube can be flexibly bent together with the insertion portion of the flexible endoscope inserted into the flexible tube.

  The endoscope guide conduit 4 is not shown in FIG. 2 except for the vicinity of the most distal portion. However, the flexible tube forming the endoscope guide conduit 4 is inserted through the entire length of the flexible insertion tube 1, and the base end thereof is located in the operation unit 2.

  In addition, in order to improve the buckling resistance of the flexible tube forming the endoscope guide conduit 4, as illustrated in FIG. 3, along the spiral groove 4c formed on the outer periphery of the flexible tube. Further, a reinforcing structure such as winding the coil spring 4d may be adopted.

  Returning to FIG. 2, the first bending portion 11 includes a plurality of (for example, about 5 to 30) short cylindrical joint rings 7 that protrude from each joint ring 7 in both the front and rear directions. It has a skeleton that is connected in series with a connecting shaft 8 so as to be rotatable relative to the adjacent articulation ring 7 and is bent in all directions as a whole. Since the articulation ring 7 only needs to have a thickness of about 0.3 to 0.4 mm, the outer diameter can be reduced.

  FIG. 4 illustrates a state in which the framework of the first bending portion 11 is bent to the maximum extent, and such a configuration and function are the same as the framework of the bending portion of a general endoscope. In addition, the arrangement of the connecting shaft 8 is changed by 90 ° at the front and rear positions of each joint ring 7. However, other angle changes (for example, 60 °, etc.) may be used.

  Returning again to FIG. 2, the tip of the first curved shape holding wire 15 </ b> A is fixedly connected to the inner peripheral portion of the most advanced joint ring 7 of the first bending portion 11. As the first curved shape holding wire 15A, a stainless steel stranded wire similar to a bending operation wire of a general endoscope can be used.

  In the first bending portion 11, the first curved shape holding wire 15 </ b> A is passed through the wire guide holes 9 that protrude inward from the inner peripheral portions of the plurality of joint rings 7 and are arranged at appropriate intervals. Although only one is shown in FIG. 2 for the purpose of clearly illustrating the structure of the other members that are guided, as shown in FIG. Four first curved shape holding wires 15A are arranged around the axis of the curved portion 11 at approximately 90 ° intervals, and the respective distal end portions thereof are fixed to the inner peripheral portion of the most advanced joint ring 7. It is connected.

  As shown in FIG. 2, each first curved shape holding wire 15 </ b> A has a flexible first guide pipe 17 </ b> A whose tip is fixed to the inner peripheral portion near the rear end of the first curved portion 11. It is inserted in the shaft so as to be movable back and forth in the axial direction. The first guide pipe 17 </ b> A is disposed in the flexible insertion tube 1 in a direction parallel to the axis, and the base end thereof reaches the operation unit 2.

  In this embodiment, a coil pipe in which a metal wire such as a stainless steel wire is closely wound with a constant diameter is used as the first guide pipe 17A. However, other pipes can be used as long as they are flexible pipes excellent in compression resistance in the axial direction.

  The first curved portion 11 is covered with a flexible and elastic outer tube 16 such as a rubber tube in a watertight manner so that the outer tube 16 is not sandwiched between the gaps between adjacent joint rings 7. A mesh tube is disposed inside the tube 16.

  In this embodiment, the entire flexible insertion tube 1 is continuously covered with one outer tube 16, but the first bending portion 11, the second bending portion 12, and the third bending portion. 13 and the flexible tube portion 14 may be covered with separate outer tube, or only the flexible tube portion 14 may be covered with a synthetic resin tube slightly harder than rubber.

  The first bending portion 11 configured as described above is configured so that the four first bending shape holding wires 15A are not fixed except at the distal end and are movable in the axial direction. The shape of the flexible endoscope inserted through the guide duct 4 can be passively changed in response to the change in shape of the insertion portion. When the base ends of all the first curved shape holding wires 15A are fixed to the operation unit 2, the shape of the first curved portion 11 cannot be changed and the bent shape is held.

  In order to prevent the first bending portion 11 from changing its shape by fixing the base ends of all the first bending shape holding wires 15A, there are at least three first bending shape holding wires 15A. That's fine. However, it is necessary to arrange the first curved shape holding wires 15 </ b> A at intervals between each other in a positional relationship in which there is no gap of 180 ° or more around the axis of the first curved portion 11.

  Further, even when four first curved shape holding wires 15A are provided as in this embodiment, each first curved shape holding wire 15A is 180 ° or more around the axis of the first curved portion 11. If they are arranged in a positional relationship where there is no gap, it is not always necessary to arrange them at equal intervals.

  The configuration of the second bending portion 12 is the same as the configuration of the first bending portion 11, and the plurality of joint rings 7 are connected in series by the connecting shaft 8 so as to be rotatable relative to the adjacent joint rings 7. As a whole, it has a framework that can be bent in any direction.

  The tip of the second curved shape holding wire 15B is fixedly connected to the inner peripheral portion of the most advanced joint ring 7 of the second curved portion 12, and each second curved shape holding wire 15B is The second bending pipe 12 is inserted into a flexible second guide pipe 17B whose tip is fixed to the inner peripheral portion in the vicinity of the rear end of the bending portion 12 so as to be movable forward and backward in the axial direction. The base end of the second guide pipe 17 </ b> B reaches the operation unit 2.

  FIG. 6 shows a cross section (VI-VI cross section in FIG. 2) perpendicular to the axis of such a second bending portion 12, and the four second curved shape holding wires 15B are the first bending. The second bending portion 12 is disposed at substantially 90 ° intervals around the axis of the second bending portion 12 at a position displaced with respect to the shape holding wire 15A.

  The second bending portion 12 configured as described above is also configured so that the four second bending shape holding wires 15B are movable in the axial direction without being fixed except at the distal ends. The shape of the flexible endoscope inserted through the guide pipe 4 can be changed passively in response to the change in shape of the insertion portion, and the base ends of all the second curved shape holding wires 15B are the operation portions. When fixed to 2, the shape change of the second bending portion 12 becomes impossible and the shape is maintained.

  The configuration of the third bending portion 13 is also the same as the configuration of the first and second bending portions 11 and 12, and is shown in FIG. 7 illustrating a cross section perpendicular to the axis (VII-VII cross section in FIG. 2). As described above, the four third curved shape holding wires 15C are displaced around the axis of the third curved portion 13 at a position displaced from the first curved shape holding wires 15A and the second curved shape holding wires 15B. They are arranged at approximately 90 ° intervals.

  As shown in FIG. 2, each of the third curved shape holding wires 15 </ b> C is a flexible third guide pipe whose tip is fixed to the inner peripheral portion near the rear end of the third curved portion 13. It is inserted in 17C so as to be movable back and forth in the axial direction. The base end of the third guide pipe 17 </ b> C reaches the operation unit 2. If the flexible tube portion 14 is not provided, the third guide pipe 17C may be omitted.

  As a result, the third bending portion 13 is also in a state where the four third bending shape holding wires 15C are movable in the axial direction without being fixed except for the distal ends, so that the endoscope guide conduit The shape of the insertion portion of the flexible endoscope inserted through 4 can be passively changed, and the base ends of all the third curved shape holding wires 15C are fixed to the operation portion 2. If it does, the shape change of the 3rd bending part 13 will become impossible, and the shape will be hold | maintained.

  In this way, the first bending portion 11, the second bending portion 12, and the third bending portion 13 connected in series are passively independent of the bending shape and bending direction of the other bending portions, respectively. Since the shape can be freely changed, the bent shape can be accurately traced by the first bending portion 11, the second bending portion 12, and the third bending portion 13 even in a three-dimensionally winding organ.

  If the base ends of all the curved shape holding wires 15A, 15B, and 15C are fixed to the operation unit 2, the bent shapes of all the curved portions 11, 12, and 13 can be held as they are, and all the curved portions 11 are retained. , 12, and 13 can be stably held without being affected by each other in a bent state (or in a straight state) on different planes.

  The flexible tube portion 14 has the same configuration as an insertion portion of a general flexible endoscope, and its framework is formed by a helical tube 18. The spiral tube 18 is formed by spirally winding a stainless steel strip or the like with a constant diameter. For example, the spiral tube 18 is configured by overlapping two spiral tubes having different winding directions.

  The outer periphery of the spiral tube 18 is covered with a mesh tube for preventing extension and twisting, and the outermost layer is covered with an outer tube 16. However, a configuration in which a short cylinder similar to the joint ring 7 is connected instead of the spiral tube may be employed.

  As shown in FIG. 8 illustrating a VIII-VIII cross section, the endoscope guide conduit 4 is disposed in the vicinity of the axial position in the flexible tube portion 14, and 12 curved shape holding wires are disposed around the endoscope guide conduit 4. 15A, 15B, and 15C are in a state of being disposed through the guide pipes 17A, 17B, and 17C.

  The flexible tube portion 14 configured in this way corresponds to the change in shape of the insertion portion of the flexible endoscope inserted into the endoscope guide conduit 4, and each bending portion 11, 12, 13. Regardless of the bending shape and the bending direction, the shape can always be passively changed, and the shape is not retained.

  FIG. 9 shows the operation unit 2 connected to the proximal end of the flexible insertion tube 1. 10 is a sectional view taken along line XX in FIG. 9, and FIG. 11 is a sectional view taken along line XI-XI. In addition, although the code | symbol of the curved shape holding wire 15 and the guide pipe 17 is "15A, 15B, 15C" and "17A, 17B, 17C" correctly, it is abbreviated as "15" and "17" below. .

  The operation portion main body 20 fixedly connected to the proximal end portion of the flexible insertion tube 1 is formed in a substantially cylindrical shape as a whole. A wire lock receiving tube 22 is fixedly attached to the operation portion main body 20 in a straight direction with respect to the proximal end portion of the flexible insertion tube 1, and the outer peripheral surface of the wire lock receiving tube 22 is fixed. And the inner peripheral surface of the operation unit main body 20 opposed to it are annular spaces in the entire length (see FIGS. 10 and 11). Reference numeral 3 shown in FIG. 9 is the above-described folding stop.

  The inner peripheral surface of the wire lock receiving tube 22 is a through-hole having a constant inner diameter, and the endoscope guide conduit 4 passes straight through the axial position of the wire lock receiving tube 22 from the flexible insertion tube 1 side, A proximal end opening 4 a of the endoscope guide conduit 4 is provided on the proximal end side of the wire lock receiving tube 22.

  A base end opening 4a of the endoscope guide conduit 4 is provided in an annular base end connecting member 23 for fixedly connecting and fixing the base end portion of the wire lock receiving tube 22 and the base end portion 20a of the operation portion main body 20. A part for watertightly fixing the wire lock to the wire lock receiving tube 22 is also arranged.

  For example, wire base end caps 25 made of, for example, a stainless steel pipe material are firmly fixed to the base end portions of the 12 curved shape holding wires 15 provided. Further, a pipe base end cap 27 made of, for example, a stainless steel pipe material is firmly fixed to the base end portion of each guide pipe 17. The wire base end cap 25 and the pipe base end cap 27 are formed in the same outer diameter size.

  The outer peripheral surface of the wire lock receiving tube 22 fixedly disposed at the axial position of the operation unit main body 20 is configured so that the base end portions of the curved shape holding wires 15 (that is, the wire base end caps 25) are individually parallel to each other. The wire receiving surface 28 is received (see FIG. 10), and the base end portion of each curved shape holding wire 15 (that is, the wire base end cap 25) slides straight along the wire receiving surface 28 in the axial direction. be able to.

  The wire receiving surfaces 28 are formed on the outer periphery of the wire lock receiving tube 22 according to the number of the curved shape holding wires 15, and are evenly arranged around the axis of the wire lock receiving tube 22 at 30 ° intervals. .

  Each wire receiving surface 28 is formed straight on the outer peripheral surface of the wire lock receiving tube 22 in parallel with the axis. Therefore, the base end portion of the curved shape holding wire 15 (that is, the wire base end cap 25) can slide very smoothly along the wire receiving surface 28 in the axial direction.

  If the wire receiving surface 28 has a tapered slope or the like whose diameter gradually increases toward the base end side, when the curved shape holding wire 15 is pushed back from the front end side to the base end side, the sliding operation is performed. When the curved shape holding wire 15 is pulled back from the proximal end side to the distal end side, the wire proximal end cap 25 is lifted from the wire receiving surface 28 and is bent by repeating the sliding operation. There is a possibility that the shape retaining wire 15 is distorted.

  However, since the wire receiving surface 28 is formed straight on the outer peripheral surface of the wire lock receiving tube 22 in parallel with the axis as described above, the base end portion of the curved shape holding wire 15 (that is, the wire base end cap 25). Can slide very smoothly along the wire receiving surface 28, and deterioration or the like is unlikely to occur even after repeated use.

  Each wire receiving surface 28 is formed in a cross-sectional shape in which a central portion in which the base end portion of the curved shape holding wire 15 (that is, the wire base end cap 25) slides is recessed from the periphery (see FIGS. 10 and 11). .

  Therefore, when the wire base end cap 25 slides along the wire receiving surface 28, it is difficult to come off from the vicinity of the center of the wire receiving surface 28. In this embodiment, the cross-sectional shape of the wire receiving surface 28 is a gentle concave surface, but may be a V-groove shape or other groove shapes.

  In this embodiment, as shown in FIG. 11 and FIG. 12 which is a partially exploded perspective view, the base end portion of the guide pipe 17 (that is, the pipe base end cap 27) is also the same as the wire base end cap 25. Each is received by the wire receiving surface 28 so as to slide straight along the wire receiving surface 28 in the axial direction. In FIG. 12, the length direction is reduced.

  As shown in FIGS. 9 to 11, in the cylindrical space between the wire lock receiving tube 22 and the operation unit main body 20, the base end portion of the curved shape holding wire 15 (that is, the wire base end cap 25). Is disposed on the wire receiving surface 28 of the wire lock receiving tube 22.

  The wire pressing member 31 has a structure in which the cylindrical body is divided into a plurality of loose spirals in the direction twisted around the axis, and in this embodiment, the wire pressing member 31 is divided into three pieces having the same shape. It is formed of 31A.

  FIG. 13 illustrates a single piece 31A of the wire pressing member 31 and a wire pressing member 31 formed by combining three divided pieces 31A into a single cylindrical shape. Each divided piece 31A of the wire pressing member 31 forms a wall portion of 120 ° in the circumferential direction of the cylindrical body, but each is formed in a shape twisted by 60 ° relatively at both ends in the longitudinal direction. ing.

  Returning to FIGS. 9 to 11, the wire pressing member 31 is disposed with the inner surface facing an area where the proximal end portions of the 12 curved shape holding wires 15 (that is, the wire proximal end cap 25) advance and retreat in the axial direction. Thus, the curved shape holding wires 15 are movably disposed in a direction in which they are pressed / separated with respect to the base end portion (that is, the wire base end cap 25).

  That is, each divided piece 31A of the wire pressing member 31 is independently movable in the radial direction, and as it moves outward, the gap between the divided pieces 31A increases and moves inward. Then, the inner peripheral surface of the wire pressing member 31 comes into tight contact with the 12 wire base end caps 25 before the divided pieces 31 </ b> A are completely brought into close contact with each other. The inner peripheral surface of the wire pressing member 31 has a substantially circular cross-sectional shape. In addition, since the wire pressing member 31 is the same length as the space in the operation part main body 20 in the longitudinal direction, it cannot move.

  Reference numeral 32 denotes a pressing drive member that drives the wire pressing member 31 in a direction in which the wire pressing member 31 is pressed / separated with respect to the base end portion (that is, the wire base end cap 25) of all the curved shape holding wires 15. The elongated pressing drive members 32 are provided in the same number as the divided pieces 31A of the wire pressing member 31 so as to be slidably engaged with the divided pieces 31A of the wire pressing member 31 along the longitudinal direction thereof. Yes.

  As shown in FIG. 13, the wire pressing member 31 and the pressing drive member 32 are relatively slidably engaged only in the longitudinal direction by rail-like slide engaging portions 33 that bite each other. It moves integrally in other directions.

  As shown in FIGS. 10 and 11, the pressing drive member 32 is slidably engaged with the slit hole 21 formed in parallel with the axis as shown in FIGS. In addition, a flange portion 32 a that is formed to protrude sideways in a T shape is formed on the edge portion of the pressing drive member 32 so as not to enter the slit hole 21.

  As a result, the pressing drive member 32 is slidable only in the direction parallel to the axis of the operation unit main body 20 and the wire lock receiving tube 22 and cannot move in the direction approaching / separating from the wire receiving surface 28.

  Returning to FIG. 9, the slide engaging portion 33 is formed in a slope shape that approaches the inner peripheral surface of the wire pressing member 31 on the proximal end side and is separated on the distal end side. As a result, when the pressing drive member 32 slides in the direction parallel to the axis of the wire lock receiving tube 22, each operation causes the divided pieces 31 </ b> A of the wire pressing member 31 to move in a direction approaching / separating from the wire receiving surface 28. Thus, the inner peripheral surface of the wire pressing member 31 is driven in a direction of pressing / separating from the wire base end cap 25. At the same time, the inner peripheral surface of the wire pressing member 31 is also pressed / separated from the pipe base end cap 27.

  The rotation operation ring 5 that is manually rotated is engaged with the operation unit main body 20 so as to be rotatable about the axis on the distal end side (left end side in FIG. 9) of the operation unit 2. In the portion, the front end of the fixed ring 35 fixedly connected to the base end portion 20a side of the operation unit main body 20 is rotatably engaged. As a result, the rotary operation ring 5 can rotate in the direction around the axis, but does not move in the axis direction.

  A series of internal thread-like spiral grooves are formed on the inner peripheral surface of the rotation operation ring 5, and an external thread ring 36 having an external thread-like spiral groove that engages with the spiral groove is formed on the rotation operation ring 5. Are arranged across both the inner periphery of the fixed ring 35 and the inner periphery of the stationary ring 35.

  As shown in FIGS. 10 and 11, the male screw ring 36 is engaged with the operation portion main body 20 in a concave and convex manner by a rectilinear engagement portion 37 that is formed straight in a direction parallel to the axis. Therefore, when the rotation operation ring 5 is rotated in the direction around the axis, the male screw ring 36 slides in a direction parallel to the axis without rotating in the direction around the axis.

  In addition, an engagement pin 38 protruding from and attached to each pressing drive member 32 is fitted in an engagement hole 39 formed in the male screw ring 36 (see FIGS. 9, 10, and 13). Therefore, the pressing drive member 32 slides in the direction parallel to the axis line integrally with the sliding motion of the male screw ring 36.

  In this way, the operation conversion mechanism that converts the rotation operation of the rotation operation ring 5 into the slide operation and transmits it to the pressing drive member 32 is constituted by the male screw ring 36 and the linearly engaging portion 37 and the like. An operation member for moving the pressing member 31 in a sliding direction includes the rotation operation ring 5 and a motion conversion mechanism (that is, a male screw ring 36, a straight engagement portion 37). The operation unit 2 is not provided with a drive means for pushing and pulling the proximal end portion of the curved shape holding wire 15 or the guide pipe 17 in the axial direction to drive it back and forth.

  In the operation unit 2 configured as described above, as illustrated in FIG. 9, in the state where the pressing drive member 32 is positioned closer to the proximal end side, as illustrated in FIGS. 9 to 11, the wire pressing is performed. The inner peripheral surface of the member 31 is separated from the wire base end cap 25 and the pipe base end cap 27 by the pressing drive member 32 at a position apart from the wire base end cap 25.

  Therefore, in this state, when the flexible insertion tube 1 is bent at each portion, the proximal end portion of each curved shape holding wire 15 and the proximal end portion of the guide pipe 17 correspond to the position, size and direction of the bending. The first bending portion 11, the second bending portion 12, the third bending portion 13, and the flexible tube portion 14 can be inserted into the endoscope guide conduit 4 respectively. The shape changes passively in response to the shape change of the insertion portion of the flexible endoscope.

  Then, when the rotation operation ring 5 is rotated, as shown in FIG. 14, the pressing drive member 32 slides forward (leftward in the drawing) together with the male screw ring 36, and FIG. 14 and the XV-XV cross section As shown in the XVI-XVI cross section and FIGS. 15 and 16, the wire pressing member 31 is pushed by the pressing drive member 32 to the side approaching the axis (that is, the side approaching the wire receiving surface 28). The inner peripheral surfaces of the three wire pressing members 31 are simultaneously tightly pressed and fixed to the wire receiving surface 28 of the wire lock receiving tube 22 at the same time by the inner peripheral surfaces of the three wire pressing members 31. .

  At this time, each of the divided pieces 31A constituting the wire pressing member 31 is formed in a shape twisted around the axis, so that the wire base end cap 25 and the pipe base end cap 27 are adjacent to the wire pressing member 31. All the wire base end caps 25 and the pipe base end caps 27 are surely pressed and fixed to the wire receiving surface 28 of the wire lock receiving tube 22 on the inner peripheral surface of the wire pressing member 31 without being caught in the gap of 31A. .

  As a result, the first bending portion 11, the second bending portion 12, and the third bending portion 13 substantially maintain the bent shape that they had immediately before being fixed, and the three bending portions 11, 12 and 13 are fixed to the independent bend magnitude and direction, so that the bend state can be maintained even in a complicated three-dimensional shape, and the bend shape is lost even if some external force is applied. Not.

  Then, if the rotary operation ring 5 is rotated in the reverse direction, the operation unit 2 returns to the original state shown in FIG. 9, and the wire base end cap 25 and the pipe base end cap 27 are all freely moved in the axial direction. It becomes a state that can be made, and the shape of all the curved portions 11, 12, 13 is passively changed in response to the shape change of the insertion portion of the flexible endoscope in the endoscope guide channel 4. Return.

  As described above, the wire lock mechanism capable of fixing and releasing the base end portions of all the curved shape holding wires 15 together is provided with the wire lock receiving tube 22 including the wire receiving surface 28, the wire pressing member 31, the wire It is comprised by the press drive member 32 for driving the press member 31, and the operation members 5, 36, 37, etc. for operating to move the press drive member 32 in the direction to slide with respect to the wire press member 31. .

  Then, the endoscope guide conduit 4 passes straight through the wire lock mechanism, and the wire pressing member 31 is formed of a cylindrical body divided into a number smaller than the number of the curved shape holding wires 15, An operation for pressing / releasing the proximal end portion of the curved shape holding wire 15 (that is, the wire proximal end cap 25) by a configuration in which the pressing drive member 32 is provided in the same number as the divided pieces 31A of the wire pressing member 31. The part 2 is configured to operate reliably with a compact configuration.

  In this embodiment, the guide lock operating device and the wire lock mechanism that can fix and release the base end portions of all the guide pipes 17 are configured as one mechanism. The apparatus may be configured separately.

  FIG. 17 shows an example of the usage state of the endoscope guide tube device. First, the distal end 51a of the insertion portion 51 of the flexible endoscope 50 inserted through the endoscope guide conduit 4 is allowed to be opened. It protrudes from the distal end of the flexible insertion tube 1 and is inserted into the stomach from the patient's mouth A via the esophagus in a state in which the curved portions 11, 12, and 13 passively change shape.

  Then, the distal end of the flexible insertion tube 1 is projected from the hole B formed in the stomach wall to the back side of the stomach, and the distal end 51a of the insertion portion 51 of the flexible endoscope 50 faces the gallbladder C or the like of the surgical target. Then, the bending shape of the bending portions 11, 12, 13 is fixed by operating the operating female screw ring 5.

  Accordingly, the bent shape of each of the bending portions 11, 12, 13 is maintained as it is, so that the treatment for the gallbladder C is performed by the endoscope treatment tool 60 or the like inserted through the treatment tool insertion channel of the flexible endoscope 50. The operation can be performed safely and smoothly, while the endoscope guide tube device is left as it is, and the flexible endoscope 50 can be replaced as quickly as necessary. Can do. Reference numeral 60 a denotes a distal end portion of the endoscope treatment tool 60.

  In addition, this invention is not limited to the said Example, For example, you may fix the base end part of the guide pipe 17 to the operation part main body 20 grade | etc., Not being movable. With this configuration, the guide pipe 17 bends in the flexible insertion tube 1 with the bending operation of the flexible insertion tube 1, but the shape maintaining function of each bending portion 11, 12, 13 is obtained. There is no hindrance.

  In addition, the wire pressing member 31 may not be formed by dividing the cylindrical body in the entire length, but may be configured to be connected to one end side. The wire pressing member 31 includes at least three cylindrical bodies. Although it is desirable to be configured to be divided to the extent, if the number of the curved shape holding wires 15 is small, the cylindrical body may be divided into two.

  Further, even if the number of the pressing drive members 32 is not necessarily the same as the number of the divided pieces 31 </ b> A of the wire pressing member 31, the pressing member 32 is in a direction of pressing / separating the wire pressing member 31 with respect to the wire base end cap 25 by the axial movement. What is necessary is just a member to drive.

DESCRIPTION OF SYMBOLS 1 Flexible insertion tube 2 Operation part 4 Endoscope guide conduit 4a Insertion part 5 Rotation operation ring (operation member) (wire lock mechanism)
7 joint ring 8 connecting shaft 11 first bending portion 12 second bending portion 13 third bending portion 14 flexible tube portion 15 bending shape holding wire 15A first bending shape holding wire 15B second bending shape holding wire 15C Third curved shape holding wire 16 Outer tube 17 Guide pipe 17A First guide pipe 17B Second guide pipe 17C Third guide pipe 20 Operation section main body 21 Slit hole 22 Wire lock receiving tube (wire lock mechanism)
25 Wire base end cap (base end portion of curved shape holding wire)
27 Pipe base end cap (base end of guide pipe)
28 Wire receiving surface 31 Wire pressing member (wire lock mechanism)
31A Divided pieces 32 Press drive member (wire lock mechanism)
33 Slide engagement portion 36 Male screw ring (operation member) (motion conversion mechanism) (wire lock mechanism)
37 rectilinear engagement part (operation member) (motion conversion mechanism) (wire lock mechanism)
38 engagement pin (operation member) (motion conversion mechanism) (wire lock mechanism)
50 Flexible endoscope 51 Insertion section

Claims (16)

Endoscope guide tube having a configuration in which a flexible endoscope guide channel that can be inserted through an insertion portion of a flexible endoscope is inserted into a flexible insertion tube that can be inserted into and removed from a body cavity. A device,
A plurality of short cylindrical joint rings are connected in series with a connecting shaft so as to be relatively rotatable with the adjacent joint rings in the whole of the flexible insertion tube or a portion near the distal end. A bending portion having a framework configured to be freely bent in a direction,
The bending portion is passively changeable in response to a change in shape of the insertion portion of the flexible endoscope inserted through the endoscope guide conduit, and maintains the shape. The tip of at least three curved shape holding wires is connected to the tip of the bending portion,
The operation portion disposed on the proximal end side of the flexible insertion tube is not provided with operation means for pushing and pulling the curved shape holding wire, and the proximal end portions of the plurality of curved shape holding wires are not provided. A wire lock mechanism is provided which is arranged so as to be movable back and forth in the axial direction and which can fix and release the base end portions of all the curved shape holding wires together.
The wire lock mechanism is
The cylindrical body is divided into a plurality of twisted directions around the axis, and the base end portions of the plurality of curved shape holding wires are arranged with their inner surfaces facing areas where they advance and retreat in the axial direction. A wire pressing member movably disposed in a direction pressed / separated with respect to the end portion;
The wire pressing member is slidably engaged along the longitudinal direction of the wire pressing member, and presses the wire pressing member against the proximal end portion of each curved shape holding wire by sliding with respect to the wire pressing member. A pressing drive member for driving in the direction of separating;
An operation member for performing an operation of moving the pressing drive member in a direction of sliding with respect to the wire pressing member;
The slide engaging portion between the wire pressing member and the pressing drive member is formed in a slope shape that approaches / separates from the wire pressing surface of the wire pressing member, so that the wire pressing member is driven by the pressing drive. An endoscope guide tube device that is pressed / separated with respect to a proximal end portion of the curved shape holding wire by a sliding operation of a member.   The endoscope guide tube apparatus according to claim 1, wherein the wire pressing member is configured by dividing the cylindrical body into at least three parts.   The endoscope guide tube apparatus according to claim 2, wherein the wire pressing member is configured by dividing the cylindrical body into a number smaller than the number of the curved shape holding wires.   The endoscope guide tube device according to claim 3, wherein the wire pressing member is formed of three divided pieces having the same shape, and each of the divided pieces is twisted by 60 ° at both ends in the longitudinal direction.   The wire pressing member and the pressing driving member are relatively slidable in the longitudinal direction of the wire pressing member in the slide engagement portion, and are in a state in which relative movement is restricted in a different direction. The endoscope guide tube device according to any one of claims 1 to 4, which is combined.   The endoscope guide tube device according to claim 5, wherein the same number of the pressing drive members as the divided pieces of the wire pressing member are slidably engaged with the divided pieces of the wire pressing member.   The operation member includes a rotation operation ring that is manually rotated, and an operation conversion mechanism that converts a rotation operation of the rotation operation ring into a slide operation and transmits the slide operation to the pressing drive member. The endoscope guide tube device according to any one of the above.   The at least three curved shape holding wires are arranged at intervals between each other in a positional relationship in which there is no interval of 180 ° or more around the axis of the bending portion. The endoscope guide tube device according to the section.   9. Each of the curved shape holding wires is inserted into a flexible guide pipe whose tip is fixed to the inner peripheral portion near the rear end of the curved portion so as to be movable back and forth in the axial direction. An endoscope guide tube device according to any one of the above items.   The endoscope guide tube device according to claim 9, wherein the guide pipe is a coil pipe formed by tightly winding a metal wire with a constant diameter.   The endoscope guide tube device according to claim 9 or 10, wherein a proximal end portion of the guide pipe is pressed and fixed / released on the wire receiving surface together with the curved shape holding wire by the wire pressing mechanism.   The endoscope guide tube device according to claim 9 or 10, wherein a proximal end portion of the guide pipe is fixed to the operation portion.   The most part of the endoscope guide pipe is formed of a flexible tube inserted and arranged in the vicinity of the axial position of the flexible insertion pipe. Endoscope guide tube device.   The endoscope guide tube device according to any one of claims 1 to 13, wherein the curved portion is covered with a flexible outer tube.   A plurality of the bending portions are connected in series, and the wire lock mechanism fixes and unlocks the base end portions of all the curved shape holding wires connected to the distal end portions of the plurality of bending portions together. The endoscope guide tube device according to any one of claims 1 to 14, which is free. In the case where the bending portion is provided at a portion near the tip of the flexible insertion tube, a portion other than the bending portion of the flexible insertion tube is inserted into the endoscope guide conduit. The flexible tube portion according to any one of claims 1 to 15, wherein the flexible endoscope portion is passively changeable in shape in response to a change in shape of the insertion portion of the flexible endoscope and has no shape retaining property. The endoscope guide tube device described.

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