JP2010259477A - Endoscope guide tube device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope guide tube device which can passively change its shape in response to a shape change of the insertion portion of a flexible endoscope and can stably retain the shape, is lightweight and easy to use, and can be easily inserted from the mouth together with the insertion portion of the flexible endoscope by easily shrinking. <P>SOLUTION: The endoscope guide tube device is structured so as to increase frictional resistance acting on operating wires 15 in the portions in contact with wire guide holes 91 with an increase in a tensile force applied to the operating wires 15 by varying the axial direction or the axial position between the wire guide holes 91 arranged in a joint wheel 7 and the wire guide holes 91 located adjacently thereto in a serial direction. When every operating wire 15 is pulled from a base end side, the frictional resistance between each of the operating wires 15 and the wire guide holes 91 increases in response to an increase in the tensile force applied to every operating wire 15 and permits a bending shape-retainable tube portion 11 to retain the bending shape. <P>COPYRIGHT: (C)2011,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 or the like 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.

  For example, Patent Documents 1 and 2 are known as an endoscope guide tube device for a flexible endoscope having such a function.

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. A large number of bowl-shaped joints are stacked in series, and a frictional resistance acts between adjacent joints by pulling the operation wire (or mesh tube, etc.) placed around it in the proximal direction. By doing so, the bent shape can be maintained.

  However, in the configuration in which many bowl-shaped joints are stacked in series, if the operation wire is not pulled, a gap is generated between adjacent joints, and when the operation wire is pulled, the adjacent joints are in close contact with each other. The total length of the flexible insertion tube changes depending on the pulling state of the operation wire, and as a result, there is a tendency that the bent shape to be held does not become as desired, and that it is not stable. In addition, the configuration in which many bowl-shaped joints are superposed has a burden on the patient when the joint part is heavy and tends to sag, or when the outer diameter is large and the flexible endoscope is inserted from the mouth together with the insertion part. There was a problem that became very large.

  The present invention can passively change the shape corresponding to the shape change of the insertion portion of the flexible endoscope and can stably hold the shape, and is lightweight, easy to use, and easily An object of the present invention is to provide an endoscope guide tube device that can be easily inserted from the mouth with a reduced diameter and an insertion portion of a flexible endoscope.

  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. In an endoscope guide tube device having a configuration of being inserted and arranged in a flexible insertion tube, a plurality of short cylindrical joint rings are respectively relative to adjacent joint rings on the whole or a part of the flexible insertion tube. In addition, a bent shape-maintainable tube portion having a framework that is connected in series with a connecting shaft so as to be freely rotatable and bent in all directions as a whole is provided. The tip of at least three operation wires having flexibility is connected, and a wire guide member in which a wire guide hole through which each operation wire passes loosely is provided in the joint ring, and is formed in each wire guide member. The wire guide holes are adjacent wires in the series direction. The wire guide hole formed in the guide member is different in axial direction or axial position, and as the tension applied to the operation wire increases, the frictional resistance acting on the operation wire at the contact portion with the wire guide hole increases. As a result, in the state where each operation wire is not pulled from the proximal end side, the bent shape-maintainable tube portion is passively changeable, and all the operation wires are connected from the proximal end side. When pulled, the frictional resistance between each operation wire and the wire guide hole increases corresponding to the increase in tension applied to all the operation wires. It is made to be done.

  A plurality of wire guide members are arranged in series on one joint ring, and the axial direction or axis line of each wire guide hole between the plurality of wire guide members arranged in series on the same joint ring The position may be different. And the some wire guide member provided in series in the same joint ring may be formed in a line.

  In addition, one wire guide member is provided in each joint ring in the series direction, and the wire guide member is provided in a serial positional relationship with adjacent joint rings. The position may be different.

  In addition, the operation portion is connected to the proximal end side of the flexible insertion tube, and the proximal end portion of each operation wire follows the bending state of the bendable tube portion so as to advance and retract in the axial direction. A wire pulling operation device for pulling the base end portions of all the operation wires together may be provided in the operation unit.

  The operation unit may be provided with wire tension adjusting means for equalizing the tension of all the operation wires, and the wire tension adjusting means may be used as a base for some of the operation wires in all the operation wires. The axial positional relationship between the first wire engaging member with which the end engages and the second wire engaging member with which the proximal end of another operation wire engages may be adjusted.

  In addition, it is preferable that at least three operation wires are arranged at intervals between each other in a positional relationship where there is no interval of 180 ° or more around the axis of the bent shape-maintainable tube portion. Four operation wires may be arranged at substantially 90 ° intervals around the axis of the bent shape-maintainable tube portion.

  Further, in the case where the bent shape-maintainable tube portion is provided near the distal end of the flexible insertion tube, the portion other than the bent shape-maintainable tube portion of the flexible insertion tube is the endoscope guide channel. In response to the shape change of the insertion portion of the flexible endoscope inserted into the flexible tube portion, it may be a flexible tube portion that is passively changeable in shape and has no shape retaining property. Alternatively, a flexible guide pipe that guides each operation wire so as to advance and retreat in the axial direction may be disposed.

  According to the present invention, it is possible to maintain the bent shape of the bendable tube portion by increasing the frictional resistance between the wire guide hole provided in the joint ring and the plurality of operation wires passing through the wire guide hole. In a state where no tension is applied to each operation wire, the bendable shape can be passively changed in response to the shape change of the insertion portion of the flexible endoscope, and all the operation wires are connected together. By pulling, it is possible to stably hold the bent shape of the tube portion that can hold the bent shape, and the bent shape holdable tube portion formed by connecting the joint rings is lightweight, easy to use, and easily It can be easily inserted from the mouth together with the insertion portion of the flexible endoscope by reducing the diameter.

  And since the wire guide member in which the wire guide hole for exhibiting such a function is formed has only a difference in the axial direction or the axial position of the wire guide member located next to the wire guide hole in the series direction. It can be easily manufactured and assembled at low cost.

FIG. 3 is a partially enlarged side cross-sectional view of a bent shape-maintainable tube portion in a state where no tension is applied to an operation wire in the endoscope guide tube device according to the first embodiment of the present invention. FIG. 3 is a partially enlarged side cross-sectional view of a bent shape-maintainable tube portion in a state where tension is applied to an operation wire in the endoscope guide tube device according to the first embodiment of the present invention. 1 is a side view showing an overall configuration of an endoscope guide tube device according to a first embodiment of the present invention. It is side surface sectional drawing of the part near the front-end | tip of the flexible insertion tube in the state in which the tension | tensile_strength is not acting on the operation wire of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is a side fragmentary sectional view of an example of an endoscope guide channel of an endoscope guide tube device concerning the 1st example of the present invention. It is a perspective view of the endoscope guide tube apparatus according to the first embodiment of the present invention in a state in which the framework of the bent shape-maintainable tube portion is bent. It is VII-VII sectional drawing in FIG. 4 of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is a perspective view of the joint ring single-piece | unit with which the wire guide member was attached of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is side surface sectional drawing of the part near the front-end | tip of the flexible insertion tube in the state which tension | tensile_strength acts on the operation wire of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is XX sectional drawing in FIG. 4 of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is side surface sectional drawing for demonstrating bending | flexion operation | movement of the frame | frame of the bending shape maintenance possible tube part in the state where the tension | tensile_strength is not acting on the operation wire of the endoscope guide tube apparatus which concerns on 1st Example of this invention. . It is side surface sectional drawing for demonstrating bending | flexion operation | movement of the frame | frame of the bending shape maintenance possible tube part in the state which tension | tensile_strength acts on the operation wire of the endoscope guide tube apparatus based on 1st Example of this invention. . It is side surface sectional drawing of the operation part of the endoscope guide tube apparatus which concerns on 1st Example of this invention. FIG. 14 is a cross-sectional view of the endoscope guide tube device according to the first embodiment of the present invention, taken along the line XIV-XIV in FIG. 13. It is a fragmentary perspective view of the wire engaging part in the operation part of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is a fragmentary perspective view of the wire engaging part in the operation part of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is a schematic diagram showing an example of a use state of an endoscope guide tube device concerning the 1st example of the present invention. It is a perspective view of the modification of the joint ring single-piece | unit with which the wire guide member was attached of the endoscope guide tube apparatus which concerns on 1st Example of this invention. It is a partial side half sectional view of the bendable tube section of the endoscope guide tube apparatus according to the second embodiment of the present invention. It is a partial side half sectional view of the bent shape maintenance possible tube part of the endoscope guide tube device concerning the 3rd example of the present invention. FIG. 10 is a partial side cross-sectional side view of a bent shape-maintainable tube portion of an endoscope guide tube device according to a fourth embodiment of the present invention. FIG. 10 is a partial side sectional half view of a bent shape-maintainable tube portion of an endoscope guide tube device according to a fifth embodiment of the present invention. It is a partial sectional side view of the modification of each wire guide member used for the 1st-3rd Example of this invention.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 3 shows the overall configuration of the endoscope guide tube apparatus according to the first embodiment of the present invention. The endoscope guide tube apparatus is flexible in all directions and can be inserted into and removed from a body cavity as a whole. The flexible insertion tube 1 and the operation unit 2 connected to the base 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.

  The portion near the tip of the flexible insertion tube 1 is a bent shape-maintainable tube portion 11 that can be bent in any direction. A portion near the base end of the flexible insertion tube 1 is a flexible tube portion 12 that can be bent in any direction.

  The difference between the bent shape-holdable tube portion 11 and the flexible tube portion 12 is that the bent shape-holdable tube portion 11 is operated by operating the internal thread ring 5 (operation member) for operation arranged in the operation portion 2. Although it can hold | maintain, the flexible tube part 12 is a point which cannot hold | maintain the bent shape, and the point is mentioned in detail later.

  Note that the flexible tube portion 12 does not necessarily have to be provided depending on the use or procedure of the endoscope guide tube device. In that case, the entire flexible insertion tube 1 becomes a bent shape-maintainable tube portion 11. Further, a rigid portion or a semi-rigid portion may be provided between the bent shape-maintainable tube portion 11 and the flexible tube portion 12 or on the proximal side of the flexible tube portion 12.

  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. Needless to say, the endoscope guide conduit 4 is not limited to the endoscope and may be used by inserting a treatment instrument, a medical probe for observation, etc. (for example, an ultrasonic probe). A plurality of such guide pipes 4 may be provided.

  FIG. 4 shows the configuration of the flexible insertion tube 1. The distal end cap 10 is formed in a substantially cylindrical shape by metal or hard plastic material or the like and is connected to the distal end portion of the bent shape-maintainable tube portion 11, and forms, for example, four portions that form most of the endoscope guide conduit 4. A distal end portion of a flexible tube made of an ethylene oxide resin tube or the like is joined and fixed to the distal end cap 10 from the rear in a watertight manner. 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 omitted in FIG. 4 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. 5, 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. 4, the bent shape-maintainable tube portion 11 includes a plurality of (for example, about 10 to 100) short cylindrical joint rings 7 in a tongue piece portion in which the joint rings 7 protrude from each joint ring 7 in both the front and rear directions. It has a framework 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. 6 illustrates a state in which the framework of such a bent shape-maintainable tube portion 11 is bent to the maximum extent, and such a configuration and function are the same as those of a curved portion of a general endoscope. The arrangement of the connecting shaft 8 changes 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. 4, the distal end of the flexible operation wire 15 is fixedly connected to the inner peripheral portion of the most advanced joint ring 7 </ b> A of the bent shape-maintainable tube portion 11. As the operation wire 15, a rope-like stainless steel stranded wire or the like similar to a bending operation wire of a general endoscope can be used, and even if a surface coating or the like is applied to improve durability. Good. In addition, a single wire may be used instead of the stranded wire. In this case, a wire made of a Ni—Ti alloy or the like having a superelastic effect that is flexible and has a small residual deformation with respect to an external force is suitable.

  In the bent shape-maintainable tube portion 11 of the first embodiment, four operation wires 15 are arranged approximately 90 ° around the axis as shown in FIG. 7 illustrating a VII-VII cross section in FIG. They are arranged at intervals and guided through the wire guide holes 91 of a plurality of wire guide members 9 arranged inwardly projecting from the inner peripheral portion of each joint ring 7.

  As shown in FIG. 8, the wire guide member 9 corresponds to the position of the connecting shaft hole 71 formed in each joint ring 7 so as to pass the connecting shaft 8. Are attached at intervals of 90 °. Reference numeral 92 denotes an attachment foot which is formed so as to protrude from each wire guide member 9, is inserted into the attachment hole of the joint ring 7, and is mechanically fixed thereto.

  As shown in FIG. 1 which is an enlarged view of a part of FIG. 4, in this embodiment, two wire guide members 9 for passing one operation wire 15 through the inner peripheral portion of each joint ring 7. Are arranged in series (that is, in a direction parallel to the axis of the articulation ring 7) and are arranged with a little space therebetween.

  The axial direction of the wire guide hole 91 is different between the plurality of wire guide members 9 provided in series with the same joint ring 7. Specifically, when the wire guide holes 91 of the two wire guide members 9 arranged in series are combined, the shape is formed in a mountain shape.

  In this embodiment, the shape of the “mountain” is convex toward the inner peripheral wall of the joint ring 7, but is convex toward the circumferential direction of the joint ring 7 or convex toward the other direction. There may be.

  Each such wire guide hole 91 is formed to have an inner diameter dimension through which the operation wire 15 passes loosely over the entire length, but as shown in FIG. 9 and FIG. When the two wire guide holes 91 are combined, the operation wire 15 is bent so as not to be straight even if the operation wire 15 is pulled from the proximal end side and becomes straight due to tension.

  In other words, when the two wire guide holes 91 are combined, the flexible operation wire 15 passes through both the wire guide holes 91 while being bent, but the hard pipe having the same diameter as the operation wire 15 is bent so as not to pass. It has a different shape. In addition, the inner peripheral wall surface part of the wire guide hole 91 with which the pulled operation wire 15 is slidably contacted, the both-end opening edge part, etc. are smoothly rounded to prevent the operation wire 15 from being damaged.

  With such a configuration, when all the four operation wires 15 are pulled simultaneously from the proximal end side, the contact with the wire guide holes 91 corresponds to the increase in the tension applied to all the four operation wires 15. The frictional resistance acting on each operation wire 15 increases at the portion, and the bent shape of the bent shape-maintainable tube portion 11 is maintained as will be described later.

  The bent shape-maintainable tube portion 11 is watertightly covered with a flexible and elastic outer tube 16 such as a rubber tube or the like, so that the outer tube 16 is not sandwiched between the gaps between the adjacent joint rings 7. A mesh tube 19 is disposed inside the outer tube 16.

  Returning to FIG. 4, the flexible tube portion 12 has the same configuration as the insertion portion of a general flexible endoscope, and its framework is formed by the spiral 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 19 for preventing extension and twisting, and the outermost layer is covered with the outer tube 16 in a watertight manner. However, a configuration in which a short cylinder similar to the articulation ring 7 is connected instead of the spiral tube 18 may be adopted, and the flexible tube portion 12 may be formed of a flexible multi-lumen tube or the like. .

  In the first embodiment, the bent shape-maintainable tube portion 11 and the flexible tube portion 12 are continuously covered with one outer tube 16 and the mesh tube 19, but the bent shape-maintainable tube portion. 11 and the flexible tube portion 12 may be covered with different skin tubes and mesh tubes, respectively, or only the flexible tube portion 12 may be covered with a synthetic resin tube or the like that is slightly harder than rubber.

  As shown in FIG. 10 illustrating the XX cross section in FIG. 4, the endoscope guide conduit 4 is arranged in the vicinity of the axial position in the flexible tube portion 12, Four operation wires 15 are disposed through the flexible guide pipe 17 so as to be movable forward and backward in the axial direction over the entire length of the flexible tube portion 12.

  Each guide pipe 17 is formed of a coil pipe in which a metal wire such as a stainless steel wire or the like is tightly wound with a certain diameter. However, any flexible pipe that has excellent compression resistance in the axial direction can be used other than the coil pipe.

  The leading ends of the four guide pipes 17 are arranged at approximately 90 ° intervals around the axis in accordance with the arrangement of the wire guide members 9 in the bent shape-holdable tube portion 11, and the bent shape-holdable tube portion 11 and the flexible tube. It is fixed to the inner periphery near the boundary with the part 12.

  And the base end of each guide pipe 17 arrange | positioned in the flexible tube part 12 in parallel with an axis line is fixed in the operation part 2 connected with the base end of the flexible tube part 12, and operation wire is sent from there. 15 base ends are extended.

  The flexible tube portion 12 configured in this manner is bent in response to the force received from the surroundings and the bending shape change of the insertion portion of the flexible endoscope inserted into the endoscope guide conduit 4. The shape is always passively three-dimensionally changeable and does not have the property of maintaining its bent shape.

  FIG. 11 and FIG. 12 each illustrate only the framework of the bent shape-maintainable tube portion 11. As shown in FIG. 11, the bent shape-maintainable tube portion 11 is passively changeable three-dimensionally in a state where the operation wire 15 is not pulled from the proximal end side, and is received from the periphery. When the bending state of the endoscope changes in the endoscope guide conduit 4 that is inserted and arranged in the flexible insertion tube 1, the follow-up follows, for example, passively as illustrated by a two-dot chain line. The bent shape changes.

  Then, as shown in FIG. 12, when all four operation wires 15 are pulled simultaneously from the proximal end side, each operation is performed in response to an increase in tension applied to all four operation wires 15. By increasing the frictional resistance between the wire 15 and the wire guide hole 91, the bent shape of the bent shape-maintainable tube portion 11 ((Note) including the straight shape when the bending angle is zero) is held, The bent shape of the tube 11 capable of holding the bent shape does not change due to a change in the state of the insertion portion of the flexible endoscope inserted into the endoscope guide conduit 4.

  As described above, in the present invention, the bent shape of the bent shape-holdable tube portion 11 can be maintained by increasing the frictional resistance acting on each operation wire 15 at the contact portion with the wire guide hole 91, and the articulation ring 7. Since the tube structure 11 is connected in series, the bent shape-maintainable tube portion 11 does not increase in weight, is light and easy to use, and can be easily reduced in diameter and easily inserted from the mouth together with the insertion portion of the flexible endoscope. can do.

  Further, even when the operation wire 15 is not pulled, the gaps between the adjacent joint rings 7 do not change, and a stable bent shape can always be exhibited. And the wire guide member 9 of this invention for exhibiting such a function can be manufactured and assembled easily at low cost.

  In order to prevent the bent shape-maintainable tube portion 11 from changing its shape by pulling all the operation wires 15 from the proximal end side, at least three operation wires 15 are sufficient. However, it is necessary to arrange each operation wire 15 with a space between each other in a positional relationship in which there is no space of 180 ° or more around the axis of the bent shape-maintainable tube portion 11.

  Further, even in the case where four operation wires 15 are provided as in the first embodiment, each operation wire 15 can be held at a position where there is no interval of 180 ° or more around the axis of the tube portion 11 capable of holding the bent shape. If arranged in a relationship, it is not always necessary to arrange them at equal intervals.

  13 and 14 show the operation unit 2, FIG. 13 is a side cross-sectional view, and FIG. 14 is a XIV-XIV cross-sectional view thereof. However, FIG. 13 illustrates different cross sections (XIII-XIII cross section in FIG. 14) in the upper half and the lower half.

  As shown in FIG. 13, the insertion tube connecting member 21 to which the base end cap 14 a of the flexible tube portion 12 is screwed and the flexible tube forming the endoscope guide line 4 is fixed. The tube fixing seat 22 is connected and fixed by four guide shafts 23.

  A proximal end portion of each guide pipe 17 is fixed to the insertion tube connecting member 21. The guide shafts 23 are arranged in parallel with the axis at 90 ° intervals around the axis of the endoscope guide conduit 4. 3 is the above-mentioned folding stop.

  The proximal end of the flexible tube forming the endoscope guide conduit 4 is sandwiched between the tube fixing seat 22 and the press taper cylinder 24 and is fixed in a watertight manner therewith. A proximal end opening 4a of the endoscope guide conduit 4 is formed in the lid member 25 that is pressed from the outside. The lid member 25 is fixed to the tube fixing seat 22 with screws or the like not shown.

  An annular seal valve 26 made of a resilient rubber material or the like may be detachably attached to the proximal end opening 4a portion of the endoscope guide conduit 4. The seal valve 26 is formed with an endoscope passage hole having an inner diameter slightly smaller than the outer diameter of the insertion portion of the flexible endoscope that is passed therethrough, and is formed on the outer surface of the insertion portion of the flexible endoscope. Press contact.

  As a result, the gap between the insertion portion and the insertion portion can be sealed without interfering with the gas or liquid without interfering with the advancement / retraction operation, rotation operation, etc. of the flexible endoscope. Therefore, it is possible to prevent leakage of air, carbon dioxide gas, or the like sent in. When used in this way, in order to send gas from outside the body to the inside of the body, it is preferable to provide an air supply channel that leads from the proximal end to the distal end of the flexible insertion tube 1.

  On the outer peripheral portion of the male screw cylinder 27 supported by the four guide shafts 23 so as to be slidable in the front-rear direction, a male screw that engages with the female screw formed on the inner peripheral portion of the operating female screw ring 5 is formed. Reference numeral 30 denotes the screwing portion.

  Although the internal thread 5 for operation is rotatably arranged around the axis, the movement in the axial direction is restricted by the cover cylinder 31 and the tube fixing seat 22 fixed to the insertion tube connecting member 21 with screws. Yes. Therefore, by rotating the operating female screw ring 5 around the axis, the male screw cylinder 27 screwed with the operating screw ring 5 is driven to advance and retreat in the axial direction along the guide shaft 23.

  In such a male screw cylinder 27, first and second wire engagement cylinders (wire engagement members) 28, 29 with which four operation wires 15 (15 (I), 15 (O)) are engaged are provided. Are connected and fixed by screws or the like not shown. Reference numeral 32 denotes a fixing screw for connecting and fixing the first wire engagement cylinder 28 and the second wire engagement cylinder 29.

  As shown in FIG. 15, the outer surface of the first wire engaging cylinder 28 formed in a substantially cylindrical shape is connected to the two integrally and is smoothly bent back into a U shape. An inner wire engagement groove 28g with which the proximal end loop portion of the operation wire 15 (I) is engaged is formed in a U shape. The two operation wires 15 (I) can be formed by one wire, and the inner wire engagement groove 28g is formed from a position 180 ° symmetrical with respect to the central axis of the first wire engagement cylinder 28. Is engaged.

  The proximal end portion of such an operation wire 15 (I) is movable forward and backward along the inner wire engagement groove 28g as shown by an arrow α, and therefore the bent shape-maintainable tube portion 11 is passively bent. At the time of operation, the proximal end portion of the operation wire 15 (I) follows the inner wire engagement groove 28g freely in the axial direction and follows the bending operation of the tube portion 11 capable of maintaining the bent shape. Does not become resistance. When the first wire engagement cylinder 28 is moved backward, the two operation wires 15 (I) are pulled with the same tension.

  A second wire engagement cylinder 29 is fitted and fixed to the outer periphery of the first wire engagement cylinder 28 as shown in FIG. The bases of the two operation wires 15 (O) in a state where they are integrally connected to the outer surface of the second wire engagement cylinder 29 formed in a substantially cylindrical shape and smoothly bent back into a U shape. The outer wire engagement groove 29g with which the end loop portion is engaged is formed in a U shape with a 90 ° phase shift from the inner wire engagement groove 28g.

  The proximal end portion of such an operation wire 15 (O) is movable back and forth along the outer wire engagement groove 29g as indicated by an arrow β, and therefore the bent shape-maintainable tube portion 11 is passively bent. At the time of operation, the proximal end portion of the operation wire 15 (O) follows the outer wire engaging groove 29g freely in the axial direction following the movement, and with respect to the bending operation of the bent shape-maintainable tube portion 11. Does not become resistance. Further, when the second wire engaging cylinder 29 is moved backward, the two operation wires 15 (O) are pulled with the same tension.

  Therefore, the first wire engaging cylinder 28 and the second wire engaging cylinder 29, which are connected and fixed by the fixing screw 32 described above, are integrated into the rear in the axial direction (each When moved to the right in the figure, the four operation wires 15 (I) and 15 (O) are pulled together.

  All the operations can be performed by adjusting the connecting position (that is, the positional relationship in the axial direction) between the first wire engaging cylinder 28 and the second wire engaging cylinder 29 and fixing with the fixing screw 32. The tension applied to the wires 15 (I) and 15 (O) can be made uniform.

  With such a configuration, in a state where the four operation wires 15 (I) and 15 (O) are not pulled to the operation unit 2 side, the bent shape-maintainable tube portion 11 can be passively bent as described above. Yes, when the operation female screw ring 5 is rotated and the four operation wires 15 are pulled together from the proximal end side, a uniform tension is generated in each operation wire 15 and bent as described above. The bent shape of the shape-maintainable tube portion 11 is maintained.

  At that time, by adjusting the amount of rotation of the operating female thread ring 5, the shape retaining force of the bent shape-maintainable tube portion 11 can be adjusted as appropriate. If the operating female thread ring 5 is returned to its original state, The shape-maintainable tube portion 11 returns to the state in which it can passively bend again.

  Note that a sealing O-ring or the like is appropriately attached to the boundary between the members constituting the operation unit 2, and the internal space in which the operation wire 15 or the like is disposed is sealed in a watertight manner to the outside. ing. Such an internal space is connected from the distal end portion of the flexible insertion tube 1 to the inside of the operation unit 2.

  Therefore, when the endoscope guide tube device is housed in a sterilizer or the like after use and placed in an environment close to a vacuum, the flexible outer tube 16 that sheathes the flexible insertion tube 1 may swell. There is sex. Therefore, a check valve that opens when the pressure in the internal space of the endoscope guide tube device is higher than the external pressure by a certain level or communicates between the internal space and the outside. If an open valve or the like (not shown) that can be maintained at this position is disposed in the operation unit 2, such a phenomenon can be prevented.

  FIG. 17 shows an example of the usage state of the above-described 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 shown. Then, the tube 11 is protruded from the distal end of the flexible insertion tube 1 and inserted into the stomach through the esophagus from the patient's mouth A in a state where the bent shape-maintainable tube portion 11 passively changes its shape.

  And the front-end | tip of the flexible insertion tube 1 is taken out to the back side of the stomach from the hole B formed in the stomach wall by the treatment tool 60 passed through the flexible endoscope 50, etc. When the distal end 51a of the insertion portion 51 faces the surgical target gallbladder C or the like from the front, the bending shape of the tube portion 11 capable of holding the bending shape is fixed by operating the internal thread ring 5 for operation.

  As a result, the bent shape of the tube portion 11 that can hold the bent shape can be held as it is for a long time, so that the endoscope treatment tool 60 or the like inserted through the treatment tool insertion channel of the flexible endoscope 50 can be used. By performing a treatment on the gallbladder C, the operation can be performed safely and smoothly. During that time, the endoscope guide tube device is left as it is, and the flexible endoscope 50 is replaced as necessary. It can be done promptly. Reference numeral 60 a denotes a distal end portion of the endoscope treatment tool 60.

  After the treatment, the bent shape-maintainable tube portion 11 may be passively returned to the bendable state, and the endoscope guide tube device and the endoscope 50 may be removed from the body at the same time. After removing only the endoscope 50, the endoscope guide tube device may be removed.

  FIG. 18 shows a modified example of the arrangement of the wire guide members 9, and the tube portions that can hold the bent shape by attaching the wire guide members 9 in two rows as a whole at 180 ° symmetrical positions of the inner peripheral portion of each joint ring 7. 11 is constituted.

  In this way, each operation wire 15 may be configured to pass through one wire guide hole 91 for each of the two articulated rings 7. Further, the wire guide member 9 in which the wire guide hole 91 is formed in parallel with the axis of the joint ring 7 may be mixed.

  FIG. 19 shows a wire guide member 9 used in the bent shape-maintainable tube portion 11 of the second embodiment of the present invention, and three wire guide members 9 are arranged in series on one joint ring 7. It is a thing.

  In this embodiment, a wire guide hole 91 is formed in the middle wire guide member 9 in a direction parallel to the axis of the articulation ring 7, and the adjacent wire guide members 9 have the same direction as in the first embodiment. A wire guide hole 91 inclined in the axial direction is formed, and when the wire guide holes 91 formed in the three wire guide members 9 are combined, the whole has a mountain shape.

  FIG. 20 shows the wire guide member 9 used in the bent shape-maintainable tube portion 11 of the third embodiment of the present invention. As in the second embodiment described above, one joint ring 7 has 3 The wire guide members 9 are arranged side by side in series, and each wire guide hole 91 is formed in a positional relationship in which the respective axis lines are decentered in a direction parallel to the axis line of the articulation ring 7 and passes therethrough. The operation wire 15 has a mountain shape in the region.

  FIG. 21 shows the wire guide member 9 used in the bent shape-maintainable tube portion 11 of the fourth embodiment of the present invention, and one wire guide member 9 is provided for each joint ring 7 in the series direction. Thus, the wire guide holes 91 are formed in a chevron shape as a whole by making the axial direction of the wire guide holes 91 different between the wire guide members 9 provided in a serial positional relationship with the adjacent joint rings 7 and combining them. It is configured to present.

  FIG. 22 shows the wire guide member 9 used in the bent shape-maintainable tube portion 11 of the fifth embodiment of the present invention, and the wire guide member 9 is arranged in the series direction as in the above-described fourth embodiment. 1, one is provided for each joint ring 7, and the axial position of the wire guide hole 91 is made different (ie, decentered) between the wire guide members 9 provided in a serial positional relationship with the adjacent joint ring 7. ), And the operation wire 15 passing therethrough has a mountain shape (or a waveform) in the entire region.

  The present invention can obtain the same operational effects as those of the above-described first or second embodiment to some extent even by the configurations of the second to fifth embodiments. Further, when a plurality of wire guide members 9 are provided in series on one joint ring 7, the plurality of wire guide members 9 may be formed in a single line as illustrated in FIG. With this configuration, manufacturing, assembly, and the like are easier.

  The present invention is not limited to the above-described embodiment. For example, as the operation wire 15, a chain-like wire or a wire having a perforated bead may be used. Any mechanism may be used as long as it can pull all the operation wires 15 at the same time and maintain the state thereof.

  The endoscope guide tube device of the present invention can also be used by being inserted into the body through a body surface opening other than the mouth or an incision in the body surface. In addition, mechanisms other than those described in each embodiment may be added to the endoscope guide tube device.

DESCRIPTION OF SYMBOLS 1 Flexible insertion tube 2 Operation part 4 Endoscope guide conduit 4a Base end opening 4b Tip opening 5 Female thread ring for operation (wire pulling operation device)
DESCRIPTION OF SYMBOLS 7 Articulated ring 8 Connecting shaft 9 Wire guide member 11 Bending shape holdable pipe part 12 Flexible pipe part 15 (15 (I), 15 (O)) Operation wire 17 Guide pipe 27 Male screw cylinder (wire pulling operation device)
28 1st wire engagement cylinder (1st wire engagement member) (wire pulling operation apparatus)
29 2nd wire engagement cylinder (2nd wire engagement member) (wire pulling operation apparatus)
32 Fixing screw (wire tension adjusting means)
50 Flexible endoscope 51 Insertion portion 91 Wire guide hole

Claims (11)

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. In the device
A plurality of short cylindrical joint rings are connected to the whole or a part of the flexible insertion tube in series with a joint shaft so as to be rotatable relative to adjacent joint rings, and can be bent in all directions as a whole. A bent shape-maintainable tube portion having a skeleton configured in the above-described configuration, and the distal end portion of the bent shape-maintainable tube portion is connected with distal ends of at least three flexible operation wires, and the articular ring In addition, a wire guide member in which a wire guide hole through which each of the operation wires passes loosely is provided,
The wire guide hole formed in each wire guide member is different in the axial direction or axial position from the wire guide hole formed in the wire guide member located next to the wire guide member in the series direction, and the tension applied to the operation wire Is configured such that the frictional resistance acting on the operation wire increases at the contact portion with the wire guide hole as
As a result, in a state where the operation wires are not pulled from the proximal end side, the bent shape-maintainable tube portion is passively changeable in shape, and all the operation wires are pulled from the proximal end side. And the frictional resistance between each of the operation wires and the wire guide hole is increased in response to an increase in tension applied to all the operation wires. An endoscope guide tube device characterized in that is held.   A plurality of the wire guide members are arranged in series on one joint ring, and between the plurality of wire guide members arranged in series on the same joint ring, the axial direction or the axis line of each wire guide hole The endoscope guide tube apparatus according to claim 1, wherein the positions are different.   The endoscope guide tube apparatus according to claim 2, wherein a plurality of wire guide members provided in series on the same joint ring are formed in a continuous manner.   One wire guide member is provided for each joint ring in the series direction, and between the wire guide members provided in series with adjacent joint rings, the axial direction of each wire guide hole or The endoscope guide tube device according to claim 1, wherein the axial positions are different.   The operation section is coupled to the proximal end side of the flexible insertion tube, and the operation is performed so that the proximal end portion of each operation wire advances and retreats in the axial direction following the bent state of the bendable tube section. 5. The wire pulling operation device for pulling together the base end portions of all the operation wires as described above is provided in the operation unit. Endoscope guide tube device.   The endoscope guide tube apparatus according to claim 5, wherein the operation section is provided with wire tension adjusting means for making the tension of all the operation wires uniform.   The wire tension adjusting means includes a first wire engaging member that engages a proximal end of a part of the operation wires in all the operation wires, and a second that engages a proximal end of another operation wire. The endoscope guide tube apparatus according to claim 6, wherein the positional relationship in the axial direction with the wire engaging member is adjusted.   The said at least 3 operation wire is arrange | positioned at intervals between each other in the positional relationship which does not have a space | interval of 180 degrees or more around the axis line of the said bent shape maintenanceable pipe part. An endoscope guide tube device according to any one of the above items.   The endoscope guide tube according to any one of claims 1 to 8, wherein as the operation wires, four operation wires are arranged at approximately 90 ° intervals around an axis of the bent shape-maintainable tube portion. apparatus.   In the case where the bent shape-maintainable tube portion is provided near the tip of the flexible insertion tube, the portion other than the bent shape-maintainable tube portion of the flexible insertion tube is the endoscope guide. 10. A flexible tube portion that is passively changeable in shape and has no shape-retaining property in response to a change in shape of an insertion portion of a flexible endoscope inserted into a conduit. The endoscope guide tube device according to any one of the above.   The endoscope guide tube device according to claim 10, wherein a flexible guide pipe that guides each operation wire so as to advance and retreat in the axial direction is disposed in the flexible tube portion.

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