JP2013085617A - Endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscope allowing the removal of a mucous tissue having adhered to a treatment device without pulling out the treatment device from a treatment device insertion channel, and allowing reliable removal of foreign matter having adhered to the treatment device.SOLUTION: The endoscope includes a treatment device opening portion 25 at in the distal end part of an insertion portion having at least an imaging portion, and includes the channel 25a communicating with the opening portion 25, and allowing insertion/extraction of the treatment device 31. The endoscope also includes a foreign matter removal portion 26 for removing the foreign matter having adhered to the treatment device 31 in at least a part of an opening edge part of the treatment device opening portion 25.

Description

  The present invention relates to an endoscope, and more particularly to an endoscope having a treatment instrument insertion channel through which a treatment instrument can be inserted.

  Conventionally, endoscopes have been widely used in the medical field and the industrial field. For example, in the medical field, an operator inserts an insertion portion of an endoscope into a subject, and displays an image in the subject taken by an imaging portion provided at the distal end of the insertion portion on a monitor. Thus, the examination inside the subject is performed.

  In addition, a treatment can be performed on a lesioned part or the like in a subject using an endoscope. The insertion portion of the endoscope is provided with a treatment instrument insertion channel through which the treatment instrument can be inserted. The surgeon inserts the treatment instrument into the channel, and from the opening at the distal end of the insertion section, the treatment instrument is inserted. The treatment tool can be used to treat a lesioned part or the like while projecting the tool and viewing the image in the subject imaged by the imaging unit.

  However, when a treatment is performed using a treatment tool, foreign matter may adhere to the treatment tool and treatment performance may be reduced. For example, when a treatment is performed using a high-frequency knife using a high-frequency current, so-called scorching such as carbonized biological tissue adheres to the surface of the knife.

  Since such foreign matter adhering to the surface of the treatment tool causes the so-called sharpness to be lost during high-frequency cauterization, conventionally, when the sharpness of the knife is reduced, the operator removes the treatment tool from the endoscope insertion portion. It was removed and the surface foreign matter was scraped off with a brush or the like. After the work, the treatment tool was again passed through the treatment tool insertion channel to continue the treatment. Therefore, the surgeon may have to perform the scraping operation many times in one case, and the efficiency of the operation is poor.

Therefore, an endoscope that can remove mucosal tissue attached to the high-frequency knife without removing the high-frequency knife from the treatment instrument insertion channel has been proposed (for example, see Patent Document 1).
In the endoscope according to the proposal, the treatment instrument swinging the treatment instrument derived from the distal end portion of the insertion portion of the endoscope in the substantially horizontal direction or the substantially vertical direction of the endoscopic image obtained by the observation means. By providing the moving table and the fluid delivery passage for supplying fluid in the swing region of the treatment tool swung by the swing table, the mucosal tissue attached to the cutting edge of the treatment tool is removed.

JP 2006-34457 A

  However, the endoscope according to the proposal can remove the mucosal tissue adhering to the treatment tool without pulling out the treatment tool from the treatment tool insertion channel, but is carbonized and firmly stuck to remove the mucosal tissue by water supply. There is a problem that the mucosal tissue may not be completely removed.

  Therefore, an object of the present invention is to provide an endoscope that can remove mucosal tissue attached to a treatment tool and reliably remove foreign matter attached to the treatment tool without pulling out the treatment tool from the treatment tool insertion channel. And

  According to one aspect of the present invention, in an endoscope having an opening at a distal end portion of an insertion portion having at least an imaging portion, and having a channel in communication with the opening and capable of inserting and removing a treatment tool, The endoscope which has the foreign material removal part for removing the foreign material adhering to the said treatment tool in at least one part of an opening edge part can be provided.

 According to the present invention, it is possible to provide an endoscope that can remove the mucosal tissue attached to the treatment instrument without removing the treatment instrument from the treatment instrument insertion channel, and can reliably remove the foreign matter attached to the treatment instrument. .

It is a block diagram which shows the structure of the endoscope as a medical device concerning the 1st Embodiment of this invention. It is a block diagram of the front end surface of the front-end | tip part 11 of the insertion part 2 concerning the 1st Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 along the III-III line | wire of FIG. 2 concerning the 1st Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 which shows the state which the foreign material adhered to the front-end | tip part 31a of the treatment tool 31 concerning the 1st Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 which shows a state when the foreign material is removed concerning the 1st Embodiment of this invention. It is a figure which shows the example of an endoscopic image when the front-end | tip part 31a of the treatment tool 31 protrudes from the treatment tool opening part 25 concerning the 1st Embodiment of this invention. It is a figure which shows the example of an endoscopic image when it draws in in the proximal end in order to remove the foreign material FM adhering to the front-end | tip part 31a of the treatment tool 31 concerning the 1st Embodiment of this invention. The surgeon according to the first embodiment of the present invention presses the distal end portion 31a against the living tissue LT while inclining the distal end portion 31a in the direction away from the direction toward the deepest part of the foreign substance removing portion 26. It is a figure which shows the example of an endoscopic image at the time. It is the fragmentary sectional view of the front-end | tip part 11 for demonstrating the example which 26 A of foreign material removal surfaces have the one convex part 26a as a foreign material removal part concerning the modification 1 of the 1st Embodiment of this invention. A portion of the distal end portion 11 for explaining an edge portion provided on a step portion 26b between the inclined surface 26B of the distal end surface 11a and the treatment instrument insertion channel 25a according to the second modification of the first embodiment of the present invention. It is sectional drawing. A description will be given of an example in which the foreign substance removing unit 26C according to the third modification of the first embodiment of the present invention is provided on a part of the periphery of the treatment instrument opening 25 so as to protrude from the distal end surface 11a. It is a fragmentary sectional view of the front-end | tip part 11 for this. It is a block diagram of the front end surface of the front-end | tip part of the insertion part 2 which concerns on the modification 4 of the 1st Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 along the XIII-XIII line | wire of FIG. It is sectional drawing of 11 A of front-end | tip parts of the insertion part 2 based on the 2nd Embodiment of this invention. FIG. 15 is a partial cross-sectional view of the distal end portion 11A of the insertion portion 2 of the endoscope 1 taken along line XV-XV in FIG. Insertion for showing a first example in which a water supply nozzle for removing foreign matter capable of supplying water toward the treatment instrument opening of the treatment instrument insertion channel is provided at the distal end section 11 in order to remove scorching at the distal end section of the treatment instrument. 3 is a configuration diagram of a distal end surface 11a1 of a distal end portion 11 of a portion 2. FIG. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 along the XVII-XVII line of FIG. Insertion section 2 for showing a second example in which foreign matter is removed by a cleaning nozzle capable of supplying water toward the treatment instrument opening of the treatment instrument insertion channel in order to remove the burning of the distal end portion of the treatment instrument. It is a block diagram of the front end surface 11a2 of the front-end | tip part 11. FIG. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 along the XIX-XIX line | wire of FIG. Insertion for showing a third example in which a front water supply port capable of supplying water toward the treatment instrument opening of the treatment instrument insertion channel is provided at the distal end section 11 in order to remove scorching at the distal end section of the treatment instrument. 4 is a configuration diagram of a distal end surface 11a3 of the distal end portion 11 of the portion 2. FIG. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 of the endoscope 1 along the XXI-XXI line | wire of FIG. FIG. 6 is a partial cross-sectional view of a treatment instrument insertion channel and a front water supply conduit of the distal end portion 11 of the insertion portion 2 for showing a fourth example using a forward water supply function in order to remove scorching of the distal end portion of the treatment instrument. is there. In FIG. 22, it is a fragmentary sectional view of the state where the treatment instrument is inserted into the treatment instrument insertion channel. It is a fragmentary sectional view of the front water supply pipe line 103a of the front-end | tip part 11 for demonstrating the switching valve 104 provided in the front water supply pipe line 103a. In order to remove the scorching of the distal end portion of the treatment instrument, only the treatment instrument insertion channel and the forward water supply conduit of the distal end portion 11 of the insertion portion 2 are shown to show a fifth example using a soft forward water supply conduit. It is a fragmentary sectional view which shows a cross section. From the treatment instrument opening 25 of the distal end portion 11 of the insertion portion 2 for showing a sixth example in which water is supplied from the distal end portion of the treatment instrument in order to remove the burning of the distal end portion of the treatment instrument. It is a fragmentary sectional view of tip part 11 when tip part 31a1 of treatment tool 31A protrudes. It is a figure for demonstrating the structure which removes the front-end | tip part of the treatment tool which protruded from the treatment tool opening part with a brush, in order to remove the burning of the front-end | tip part of a treatment tool. In order to remove the scorching of the distal end portion of the treatment instrument, a configuration is described in which the distal end portion of the treatment instrument protruding from the treatment instrument opening is removed by an elastic foreign substance removing member provided in the treatment instrument opening 25. FIG. 6 is a partial cross-sectional view of the treatment instrument opening 25 of the distal end portion 11 of the insertion section 2 when the distal end portion 31a2 of the treatment instrument 31B protrudes from the treatment instrument opening portion 25. FIG. It is a fragmentary sectional view of treatment instrument opening part 25 of tip part 11 of insertion part 2 when removing a foreign substance adhering to the tip part of treatment tool 31B. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 which shows the channel tube for a treatment tool penetration channel. It is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 which shows the channel tube for a treatment tool penetration channel. 4 is a cross-sectional view for explaining a configuration of a channel tube 122. FIG. It is a figure for demonstrating the state of 31 C of treatment tools which drive | work the inside of the channel tube 122 when bending operation is performed. FIG. 4 is a cross-sectional view of a tip portion 11. It is a figure for demonstrating a mode that the light guide 22a is assembled | attached in a front-end | tip hard member.

Embodiments of the present invention will be described below with reference to the drawings.
In each drawing used for the following explanation, in order to make each constituent element large enough to be recognized on the drawing, there are some constituent elements that have different scales. It is not limited only to the quantity of the component described in the drawing, the shape of the component, the ratio of the size of the component, and the relative positional relationship of each component.
(First embodiment)
(Constitution)
FIG. 1 is a configuration diagram showing a configuration of an endoscope as a medical device according to the present embodiment. The endoscope 1 extends from an elongated insertion portion 2 to be inserted into an observation target site in a subject, an operation portion 3 connected to the proximal end portion of the insertion portion 2, and a side surface of the operation portion 3. And a universal cable 4.

  The elongate insertion portion 2 has a distal end portion 11 that is a distal end rigid portion on which an imaging unit or the like is mounted at the distal end, and a bending portion 12 as a movable portion that can be bent is provided on the proximal end side of the distal end portion 11. Has been. Further, a long and flexible flexible tube portion 13 formed of a tubular member having a soft surface is continuously provided on the proximal end side of the curved portion 12.

  The operation unit 3 is arranged in the vicinity of the operation unit main body 14 constituting the operation gripping unit, the folding unit 15 connected to the proximal end side of the flexible tube unit 13 of the insertion unit 2, and the folding unit 15. And the opening 16 of the treatment instrument insertion channel in the inserted portion 2.

  A plurality of bending operation knobs 17 for bending the bending portion 12 of the insertion portion 2 are rotatably disposed in the operation portion main body 14 and are operated by a user for air supply / water supply and the like. Class 18 etc. are provided. The bending operation knob 17 includes a UD bending operation knob for bending the bending portion 12 in the up-down direction and an RL bending operation knob for bending the bending portion 12 in the left-right direction. It is arranged.

  FIG. 2 is a configuration diagram of the distal end surface of the distal end portion 11 of the insertion portion 2. FIG. 2 shows the configuration of the distal end surface when the distal end surface of the distal end portion of the insertion portion 2 is viewed in plan. As shown in FIG. 2, an observation window 21, illumination windows 22 and 23, a cleaning nozzle 24, and a treatment instrument opening 25 are provided on the distal end surface 11 a of the distal end portion 11.

  On the proximal end side, that is, behind the observation window 21 that is the objective window, the observation light from the subject that has passed through the observation window 21 is imaged and displayed as an endoscopic image (see FIG. 6) on the monitor of the endoscope apparatus. An image pickup unit 21a (see FIG. 3) including an objective lens and an image pickup device is disposed. An illumination lens and a light guide (or a light emitting element) for irradiating a subject with illumination light from each illumination window are disposed on the base end side, that is, behind the illumination windows 22 and 23. On the proximal end side, that is, behind the cleaning nozzle 24, there is a water supply conduit through which water flows so as to clean the surface of the observation window 21 from the cleaning nozzle 24 with water, and is connected to the cleaning nozzle 24. An imaging unit, a light guide, a water supply conduit, a treatment instrument insertion channel, and the like are attached in a distal end hard member (not shown).

  The treatment instrument opening 25 communicates with a treatment instrument insertion channel 25a (see FIG. 3) in the insertion section 2, and a treatment instrument (for example, an electric knife) inserted from the opening 16 of the operation section 3 opens the treatment instrument. It is an opening configured to be able to project and retract from the portion 25.

  A foreign substance removal surface 26 for removing foreign substances attached to the treatment instrument is formed on a part of the opening edge of the treatment instrument opening 25. The foreign substance removal surface 26 as the foreign substance removal part is formed so that a part of the opening edge part on the observation window 21 side is scraped off at the opening edge part of the treatment instrument opening part 25.

  FIG. 3 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1 taken along line III-III in FIG. In FIG. 3, only relevant constituent members are shown, and other members are omitted. The tip portion 11 has a tip cover 11b attached to the tip side of a tip hard member (not shown). The proximal end side of the distal end hard member is covered with a sheath 11d fixed to the distal end hard member by a thread winding portion 11c. In FIG. 3, a part of the imaging unit 21 a provided on the proximal end side of the observation window 21 and a treatment instrument insertion channel 25 a communicating with the treatment instrument opening 25 are shown. That is, the endoscope 1 has a treatment instrument opening 25 at least at the distal end portion 11 of the insertion section 2 having an imaging section, and a treatment instrument insertion channel 25a through which the treatment instrument 31 can be inserted and removed. Have.

As shown in FIGS. 2 and 3, the foreign matter removal surface 26 is formed so that the depth from the distal end surface 11a increases and the width of scraping on the distal end surface 11a increases as the distance from the observation window 21 increases. Has been. In other words, the foreign substance removal surface 26 is a recess formed so that the portion closest to the center of the observation window 21 at the opening edge of the treatment instrument opening 25 is deepest.
Furthermore, when the distal end surface 11a of the distal end portion of the insertion portion 2 is viewed in plan, a foreign substance removing surface is formed on a line LC (indicated by a two-dot chain line) connecting the center of the treatment instrument opening 25 and the center of the observation window 21. The center of the opening edge cut away so as to form 26 is positioned, and on this line LC, the edge of the foreign matter removal surface 26 comes closer to the observation window 21 and moves away from the line LC. 26 edges are formed so as to be far from the observation window 21.

  Therefore, since the foreign substance removal surface 26 has such an inclined surface, as will be described later, the inclination direction when the distal end portion 31a of the treatment instrument 31 is inclined against the living tissue is deviated from the line LC. Even so, the tip 31a is naturally guided such that the tip 31a slides along the inclined surface of the foreign substance removing surface 26 and the inclined direction thereof coincides with the line LC.

  In addition, when the distal end portion 31a of the treatment instrument 31 is in contact with the foreign matter removal surface 26, the foreign matter removal surface 26 has the distal end portion 31a of the treatment instrument 31 in the endoscopic image at the opening edge of the treatment instrument opening portion 25. It is formed in a range that falls within the range to be captured (that is, the visual field range of the imaging unit). Therefore, the distal end portion 31a of the treatment instrument 31 is reflected in the field of view of the imaging unit, so that the operator can reliably remove foreign matter. In addition, since the foreign matter removing surface 26 is provided only at a part of the opening edge of the opening 25, that is, at a minimum, the restriction on the degree of freedom of the layout of the distal end surface of the distal end portion of the insertion portion 2 is reduced. This leads to the meridianization of the insertion portion 2.

  In addition, the range in the opening edge part of the treatment tool opening part 25 in which the foreign material removal surface 26 is formed may be a slightly wide range including the field-of-view range of the imaging unit described above, as indicated by a dotted line R1 in FIG.

  The surface of the foreign matter removal surface 26 is a surface having a surface property different from that of the tip surface 11a, and has fine irregularities, for example. As will be described later, the unevenness is such an extent that foreign matter attached to the distal end portion of the treatment tool can be scraped off. For example, the foreign matter removal surface 26 has an uneven file shape so as to improve the removal property of the foreign matter.

As described above, the foreign matter removing surface 26 that is a foreign matter removing portion for removing the foreign matter attached to the treatment instrument 31 is provided on at least a part of the opening edge of the treatment instrument opening 25. The foreign matter removal surface 26 is provided on a part of the observation window 21 side which is an objective window for an imaging unit which is an imaging unit at the opening edge. The foreign substance removal surface 26 is an uneven surface that is provided at the distal end portion 11 of the insertion portion 2 and is inclined with respect to the insertion / extraction direction of the treatment instrument 31.
(Function)
How the foreign matter attached to the distal end portion 31a of the treatment instrument 31 is removed will be described with reference to FIGS.
In FIG. 3, the treatment instrument 31 is inserted into the treatment instrument insertion channel 25 a, and the distal end portion 31 a protrudes from the treatment instrument opening 25. For example, the operator uses the endoscope 1 to insert a treatment tool 31 that is an electric scalpel using a high-frequency current through the treatment tool insertion channel 25a, and performs endoscopic submucosal dissection (ESD). Dissection) can be performed. In FIG. 3, the distal end portion 31a of the treatment tool 31 touches the living tissue LT including the lesioned portion.

  In the endoscopic submucosal dissection description, the surgeon is the distal end of the treatment tool 31 that is an ESD knife (flex knife, IT knife, etc.) from the treatment tool opening 25 of the treatment tool insertion channel 25a of the endoscope 1. The part 31a is protruded, the distal end part 31a is inserted into the submucosal layer within the observation visual field range displayed on the monitor of the endoscope apparatus, and the mucosa can be peeled off by energizing with the high frequency cautery apparatus. At that time, the surgeon performs the bending operation of the endoscope 1 while adjusting the protrusion length of the distal end portion 31a of the treatment instrument 31 from the distal end portion 11, and performs incision and peeling while changing the direction of the distal end portion 31a. .

  When energization is repeatedly performed and incision and peeling are continued, the scorching of the knife due to blood or the like adheres to the surface of the tip 31a. FIG. 4 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1, showing a state in which a foreign object has adhered to the distal end portion 31 a of the treatment instrument 31. FIG. 4 shows a state in which a foreign object FM such as a living tissue is attached to the entire outer surface of the tip 31a.

FIG. 5 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1 showing a state when the foreign matter is removed.
When the surgeon removes the foreign matter FM attached to the distal end portion 31a, first, the distal end portion 31a is treated according to the distance from the biological mucous membrane LT while viewing the endoscopic image displayed on the monitor of the endoscope apparatus. It protrudes from the tool opening 25.

  Then, the prescriber presses the distal end portion 31a (for example, ESD knife) of the treatment instrument 31 against the biological mucous membrane LT, and removes the foreign matter provided in the treatment instrument opening 25 of the treatment instrument insertion channel 25a as shown in FIG. Tilt so as to press the tip 31 a against the surface 26. By tilting the distal end portion 31 a in this way, the distal end portion 31 a of the treatment instrument 31 comes into contact with the foreign substance removal surface 26. In this contacted state, when the treatment instrument 31 is moved back and forth along the axial direction of the insertion portion 2, the distal end portion 31 a of the treatment instrument 31 faces the foreign object removal surface 26 as indicated by arrows in FIG. 5. Moving. As a result, the foreign matter FM of the tip portion 31a and the foreign matter removal surface 26 rub against each other, so that the foreign matter FM such as burnt or filth attached to the surface of the tip portion 31a is mechanically removed. In the state where the distal end portion 31a of the treatment instrument 31 is in contact with the foreign matter removing surface 26, the insertion portion 2 may be moved back and forth along the axial direction of the insertion portion 2, and the distal end portion 31a of the treatment instrument 31 is a foreign matter. It moves relative to the removal surface 26.

  After removal of the foreign matter FM, the distal end portion 31a is pressed against the foreign matter removal surface 26 and tilted by appropriately securing a distance from the living tissue LT that has pressed the distal end portion 31a of the treatment instrument 31. As shown in FIG. 3, the operator returns to the state of being released straight from the pressed state against the foreign substance removal surface 26 and straightened, so that the surgeon can perform normal treatment.

  6 to 8 are diagrams illustrating examples of endoscopic images displayed on the monitor of the endoscopic device. FIG. 6 is a diagram illustrating an example of an endoscopic image when the distal end portion 31a of the treatment instrument 31 is protruded from the treatment instrument opening 25. FIG. In the endoscopic image 41 of FIG. 6, the distal end portion 31a of the treatment instrument 31 and the sheath portion 31b on the proximal end side of the distal end portion 31a are displayed. The surgeon can perform treatment on the living tissue LT while viewing the endoscopic image 41 shown in FIG.

  When the foreign object FM adheres to the surface of the distal end portion 31a of the treatment instrument 31, the operator pulls the treatment instrument 31 toward the proximal end (that is, the distal end portion 31a is inserted into the treatment instrument insertion channel 25a of the treatment instrument opening 25). The endoscope image is as shown in FIG.

FIG. 7 is a diagram illustrating an example of an endoscopic image when drawn in to the proximal end side in order to remove the foreign matter FM attached to the distal end portion 31a of the treatment instrument 31. As shown in FIG. 7, a foreign object FM (indicated by a two-dot chain line) is attached to the tip 31a.
While viewing the endoscopic image 41 of FIG. 7, the surgeon pressed the distal end portion 31a of the treatment instrument 31 against the living tissue LT while maintaining the state where the distal end portion 31a was reflected in the endoscopic image. In this state, for example, by moving the treatment tool 31 back and forth along the axial direction of the insertion portion 2, it is possible to remove foreign matters attached to the distal end portion 31 a.

  FIG. 8 shows an endoscopic image when the surgeon presses the distal end portion 31a against the living tissue LT while inclining the distal end portion 31a in a direction away from the direction toward the deepest part of the foreign substance removing portion 26. It is a figure which shows an example.

For example, in FIG. 2, it is assumed that the surgeon presses the distal end portion 31a against the living tissue LT as indicated by a two-dot chain line L1.
As shown in FIGS. 2 and 3, the foreign substance removal surface 26 is the most distal end surface in the cross section perpendicular to the line LC connecting the center of the treatment instrument opening 25 and the center of the observation window 21. It is formed to be deepest from 11a. Therefore, as shown in FIG. 8, even if the surgeon inclines the distal end portion 31a against the biological mucous membrane LT while inclining the distal end portion 31a in the direction away from the deepest central portion of the foreign substance removing portion 26, the distal end portion 31a naturally moves along the surface of the foreign substance removing portion 26 in the direction toward the deepest central portion. That is, even if the distal end portion 31a is pressed against the living tissue LT in the direction indicated by the two-dot chain line L1 in FIG. 2, the distal end portion 31a remains in the direction A1 toward the deepest central portion of the foreign substance removal surface 26 indicated by the line LC. Naturally corrected. Also on the endoscope screen 41 in FIG. 8, the surgeon can see this correction by changing the distal end portion 31a in the direction indicated by the arrow A1.

  Therefore, according to the foreign matter removal surface 26 described above, when the surgeon presses the treatment tool 31 against the living tissue LT and tilts the distal end portion 31a, the distal end portion 31a is more reliably reflected in the observation field of view of the endoscope. Therefore, the surgeon can perform a foreign substance removing operation such as scorching at the approximate center of the endoscopic image.

  Further, since the foreign substance removal surface 26 is provided at least at a part of the opening edge of the treatment instrument opening 25 of the treatment instrument insertion channel 25a, the inner diameter of the treatment instrument insertion channel 25a is not reduced, and the treatment instrument The penetrability is not affected, and as a result, normal operability is ensured.

A modification of the above-described embodiment will be described.
(Modification 1)
The foreign matter removing surface 26 described above is uneven, but may be a surface having one or more protrusions. FIG. 9 is a partial cross-sectional view of the distal end portion 11 for explaining an example in which the foreign matter removing surface 26A has one convex portion 26a as a foreign matter removing portion. Similarly to the foreign substance removal surface 26 shown in FIG. 2, the foreign substance removal surface 26 </ b> A in FIG. 9 is also a plane inclined with respect to the insertion / extraction direction of the treatment instrument 31. The foreign matter FM at the tip 31a can also be removed by one convex portion 26a formed on the foreign matter removal surface 26A as shown in FIG. In addition, the convex part 26a may be a dot-like protrusion shape or a blade shape. Furthermore, the convex part 26a may be two or more.
(Modification 2)
Furthermore, the foreign substance removal part mentioned above may be the edge part provided in the level | step-difference part with the treatment tool penetration channel 25a. FIG. 10 is a partial cross-sectional view of the distal end portion 11 for explaining an edge portion provided at a step portion 26b between the inclined surface 26B of the distal end surface 11a and the treatment instrument insertion channel 25a. The inclined surface 26B of FIG. 10 is also formed at the same position as the foreign matter removal surface 26 shown in FIG. On the treatment instrument insertion channel 25a side of the stepped portion 26b, an edge portion 26b1 as a foreign matter removing portion is formed. That is, the foreign substance removing unit is formed by an inclined surface that is inclined with respect to the insertion / extraction direction of the treatment instrument 31 provided at the distal end portion of the insertion part 2 and an inner wall surface of the treatment instrument insertion channel 25 a that communicates with the treatment instrument opening 25. It is the edge part formed in the boundary part.

Therefore, the foreign matter FM at the distal end portion 31a of the treatment instrument 31 can be removed also by the edge portion 26b1 provided in the step portion 26b as shown in FIG.
(Modification 3)
Furthermore, the foreign substance removal part may be provided in the front end surface 11a. FIG. 11 is a partial cross-sectional view of the distal end portion 11 for explaining an example in which the foreign substance removing portion 26C is provided in a part around the treatment instrument opening 25 so as to protrude from the distal end surface 11a.

  The foreign matter removing portion 26C in FIG. 11 is also formed at the same position as the foreign matter removing surface 26 shown in FIG. 2 when the distal end surface of the distal end portion of the insertion portion 2 is viewed in plan. The foreign matter removing portion 26C is provided on the treatment instrument opening 25 side of the protruding portion 26c protruding from the distal end surface 11a. The foreign matter removing portion 26C has an uneven portion like the foreign matter removing surface 26 described above. Further, the height of the protruding portion 26c provided with the foreign matter removing portion 26C from the front end surface 11a is lower than the plane PP including the tangent line (shown by a one-dot chain line) between the cleaning nozzle 24 and the peripheral portion of the front end cover 11b. Have

That is, the foreign matter removing portion 26C is provided in the protruding portion 26c protruding from the distal end surface of the distal end portion of the insertion portion 2, and the protruding portion 26c is formed between the cleaning nozzle 24 provided in the distal end portion and the outer peripheral portion of the distal end portion. Even if the tip part is in a position lower than the plane PP including the tangent line and the tip part comes into contact with the living tissue LT, the foreign substance removing unit 26C does not damage the living tissue LT.
Therefore, the foreign matter FM at the tip 31a can be removed also by the foreign matter removing portion 26C as shown in FIG.
(Modification 4)
In the above-described embodiment, the foreign substance removal surface 26 is provided at a part of the opening edge of the treatment instrument opening 25, but the foreign substance removal surface is around the opening edge of the treatment instrument opening 25, that is, the whole. It may be provided over the circumference.

  FIG. 12 is a configuration diagram of the distal end surface of the distal end portion of the insertion portion 2 according to this modification. FIG. 13 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1 taken along line XIII-XIII in FIG.

In the fourth modification, the foreign substance removal surface 26 </ b> D that is a foreign substance removal part is provided over the entire circumference of the opening edge of the treatment instrument opening 25. Also with such a configuration, the foreign matter FM at the distal end portion 31a can be removed. The foreign substance removal surface 26D also has irregular file-like irregularities so as to enhance the removal of foreign substances. According to the endoscope of the fourth modification, even if the inclination of the distal end portion 31a of the treatment instrument 31 is directed to any angle, it is possible to remove foreign matters such as scorching. In particular, when it is difficult to press the treatment tool in only one direction due to the position of the endoscope 1 in the subject or the anatomical characteristics of the subject, the distal end portion 31a of the treatment tool 31 is inclined in any direction. In addition, since it can be rubbed against the foreign matter removing portion, the foreign matter can be reliably removed.
In the fourth modification, the foreign substance removal surface as the foreign substance removal part has a concavo-convex part, but the foreign substance removal part in the fourth modification example is a foreign substance removal part as in the first and second modifications described above. It may be.

  As described above, according to the endoscopes according to the above-described embodiments and modifications, the operator can remove the treatment tool to which a foreign object such as a burnt adheres from the body without brushing the object. Can remove foreign matter.

For example, in endoscopic submucosal dissection (ESD), when the mucous membrane is repeatedly incised and peeled by high-frequency cauterization, the knife part of the ESD treatment tool is attached to mucous tissue deposits, blood, carbide, etc. The burnt due to adheres and the sharpness during high-frequency cauterization falls accordingly. Conventionally, when scorching occurs and sharpness falls, the treatment is interrupted, the ESD treatment tool is temporarily removed from the endoscope, the scorching of the knife part is scraped off with a brush, and then again to the treatment tool insertion channel. The procedure of inserting and resuming treatment was repeated, which was a very complicated operation. However, according to the endoscope of the present embodiment and each modification described above, such a complicated operation is not necessary, foreign matter can be removed in the subject, operator's fatigue can be reduced, and the procedure time can be shortened. It leads to.
(Second Embodiment)
In the first embodiment, the surgeon inclines the distal end portion of the treatment tool against the living tissue and makes the distal end portion contact the foreign substance removing portion. However, the endoscope according to the present embodiment Has a pressing structure that allows the surgeon to press the distal end portion of the treatment instrument against the foreign substance removing portion without pressing the distal end portion of the treatment instrument against the living tissue.

FIG. 14 is a cross-sectional view of the distal end portion 11A of the insertion portion 2 according to the present embodiment. FIG. 14 is a cross-sectional view orthogonal to the axial direction of the insertion portion 2. FIG. 15 is a partial cross-sectional view of the distal end portion 11A of the insertion portion 2 of the endoscope 1 taken along line XV-XV in FIG. FIG. 14 is a partial cross-sectional view of the distal end portion 11A of the insertion portion 2 of the endoscope 1 along the line XIV-XIV in FIG.
In the present embodiment, the same components as those in the endoscope according to the first embodiment are denoted by the same reference numerals, description thereof will be omitted, and different configurations will be described.

  As shown in FIG. 14, in the distal end portion 11A, an imaging unit 21a disposed on the proximal end side of the observation window 21, and a light guide (or light emitting element) 22a disposed on the proximal end side of the illumination windows 22 and 23. , 23a, a water supply conduit 24a connected to the cleaning nozzle 24, and a treatment instrument insertion channel 25a.

  In the present embodiment, the foreign substance removing portion 26E is formed at a part of the opening edge portion of the treatment instrument opening portion 25 of the distal end cover 11b1, as shown in FIG. The foreign matter removing unit 26E has a blade shape.

  Further, a pressing mechanism 51 that presses the distal end portion 31a of the treatment instrument 31 against the foreign substance removing portion is provided in the distal end portion 11A. The pressing mechanism 51 includes a guide wire 52, a movable member 53 connected to the guide wire 52, and a guide base 54. As shown in FIG. 15, the guide table 54 is disposed in a space portion 25A on the proximal end side of the treatment instrument opening 25, and can be rotated in the space portion 25A as described later.

  The guide wire 52 is inserted into a guide wire channel 11 e for the guide wire 52 provided in the insertion portion 2 so that the guide wire 52 can move in the axial direction of the insertion portion 2. By operating an operating lever (not shown) or the like provided, it is possible to pull in the base end side. For example, the guide wire 52 is constantly biased by a spring member or the like so as to be pulled toward the proximal end side of the insertion portion 2, and when the operation lever is operated, the guide wire 52 is pulled toward the proximal end side of the insertion portion 2. It has come to be.

  The columnar movable member 53 connected to the tip of the guide wire 52 has a small-diameter portion 53a that is partially thinned. Along with the movement of the guide wire 52 in the axial direction of the insertion portion 2, the movable member 53 also moves along the axial direction. The movable member 53 is movable between two positions, a position on the distal end side of the distal end portion 11A and a position on the proximal end side.

  The guide table 54 is a member that can rotate around a shaft member 55 that is fixed to the distal end rigid member 11 f of the distal end portion 11. The guide table 54 includes a pressing portion 54 a that presses the distal end portion 31 a and an engaging portion 54 b that engages with the small-diameter portion 53 a of the movable member 53.

As shown in FIG. 14, the pressing portion 54 a has a substantially semi-cylindrical shape, and has a shape in which the distal end portion 31 a of the treatment instrument 31 engages inside the substantially semi-cylindrical shape.
The guide base 54 is a substantially L-shaped member, and one extending portion of the L-shaped member is a pressing portion 54a, and the other extending portion is an engaging portion 54b. As shown in FIG. 15, the shaft member 55 is disposed so as to pass through the bent portion of the L-shaped member.

  Since the engaging portion 54b of the guide table 54 is engaged with the small-diameter portion 53a of the movable member 53, the guide table 54 rotates around the shaft member 55 when the movable member 53 moves to the proximal end side. To do. When the movable member 53 is located at the distal end side of the distal end portion 11A, the pressing portion 54a is located on the inner wall surface side in the space portion 25A, and when the movable member 53 is located at the proximal end side position of the distal end portion 11A. The guide table 54 and the movable member 53 are arranged so that the pressing portion 54a is located at the central portion in the space portion 25A.

  For example, when the operator operates an operation lever or the like so as to pull the guide wire 52 in the operation unit 3, the movable member 53 is pulled to the proximal end side by the guide wire 52 and moves to the proximal end position. As a result, the guide table 54 rotates around the axis of the shaft member 55, and the pressing portion 54a moves to the central portion of the space portion 25A of the distal end portion 11A. At this time, if the distal end portion 31a of the treatment instrument 31 is in the distal end portion 11A, the distal end portion 31a is pressed and inclined by the pressing portion 54a, and abuts against and presses against the foreign substance removing portion 26E in the inclined direction. It is done.

  When the surgeon moves the treatment tool 31 back and forth while the distal end portion 31a is in contact with the foreign matter removing portion 26E, the foreign matter attached to the surface of the distal end portion 31a can be scraped off by the foreign matter removing portion 26E.

  As described above, in the endoscope according to the present embodiment, the pressing mechanism having the treatment instrument guide base that can guide the distal end portion of the treatment instrument to the foreign substance removal unit is provided in the vicinity of the treatment instrument opening of the treatment instrument insertion channel. Is provided. And the press part 54a of the guidance base 54 is arrange | positioned in the treatment tool opening part 25, and the foreign material removal part 26E is arrange | positioned in the position facing the position where the press part 54a is arrange | positioned. When the guide wire 52 is pulled toward the proximal end side by the pulling means, the guide table 54 rotates around the axis of the shaft member 55, and the pressing portion 54a presses the distal end portion 31a of the treatment instrument 31 against the foreign substance removing portion 26E. In this state, when the prescriber advances and retracts the treatment instrument 31, the distal end portion 31 a and the foreign substance removal unit 26 </ b> E rub against each other, so that the foreign substance attached to the treatment instrument 31 can be removed.

  As described above, according to the present embodiment, without pressing the distal end portion of the treatment tool against the living tissue, the surgeon can easily press the distal end portion against the foreign substance removing portion by an operation at hand, Operability is improved.

In the above example, the foreign matter removing portion 26E is provided on the component member side (the tip cover 11b1 in the above) of the tip portion 11, but is not provided on the pressing mechanism (for example, the surface of the pressing portion 54a of the guide table 54). It may be provided.
Furthermore, also in the present embodiment, the modifications 1, 2, and 3 described in the first embodiment can be applied.

By the way, various devices related to the endoscope include the following. In the following description, the same components as those described above are denoted by the same reference numerals and description thereof is omitted.
First, in order to remove the foreign matter at the distal end of the treatment instrument, various methods for removing by water supply will be described.

  FIGS. 16 and 17 show a first example in which the distal end portion 11 is provided with a foreign matter removing water supply nozzle capable of supplying water toward the treatment instrument opening portion of the treatment instrument insertion channel in order to remove scorching at the distal end portion of the treatment instrument. An example is shown.

  FIG. 16 is a configuration diagram of the distal end surface 11 a 1 of the distal end portion 11 of the insertion portion 2. FIG. 16 shows the configuration of the distal end surface when the distal end surface of the distal end portion of the insertion portion 2 is viewed in plan. As shown in FIG. 16, the distal end surface 11a1 of the distal end portion 11 is provided with an observation window 21, illumination windows 22, 23, a cleaning nozzle 24, and a treatment instrument opening 25, and further a foreign matter removing water supply nozzle. 101 is also provided.

FIG. 17 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1 along the line XVII-XVII in FIG.
As shown in FIG. 17, in the state where the distal end portion 31a of the treatment instrument 31 protrudes from the distal end surface 11a1, by performing a water supply operation with a hand operation or a foot switch, water is supplied from the foreign matter removing water supply nozzle 101, It is possible to remove foreign matters such as burns attached to the tip 31a by water pressure. The water supply line 101a may be supplied in a form branched from an air / water supply line for washing the objective lens surface of the observation window 21, or a dedicated line may be provided and connected to a water supply pump.

  Even with the above-described configuration, the operator can selectively remove the knife portion of the treatment tool to which foreign objects such as scorch adhere from the endoscope without removing the knife portion from the endoscope, and continue the treatment. Can be done.

18 and 19 show a second example in which foreign matter is removed by a cleaning nozzle capable of supplying water toward the treatment instrument opening of the treatment instrument insertion channel in order to remove the scorching of the distal end portion of the treatment instrument. Show.
FIG. 18 is a configuration diagram of the distal end surface 11 a 2 of the distal end portion 11 of the insertion portion 2. FIG. 18 shows the configuration of the distal end surface when the distal end surface of the distal end portion of the insertion portion 2 is viewed in plan. As shown in FIG. 18, the distal end surface 11a2 of the distal end portion 11 is provided with an observation window 21, illumination windows 22, 23, a cleaning nozzle 24A, and a treatment instrument opening 25.

  FIG. 19 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1 along the line XIX-XIX in FIG. As shown in FIGS. 18 and 19, the water supply direction of the cleaning nozzle 24 </ b> A is directed to the observation window 21 and the treatment instrument opening 25. That is, as shown in FIG. 18, the cleaning nozzle 24 </ b> A for cleaning the observation window 21, the center of the observation window 21, and the center of the treatment instrument opening 25 are arranged so as to be substantially aligned.

  As shown in FIG. 19, in the state where the distal end portion 31 a of the treatment instrument 31 protrudes from the distal end surface 11 a 1, water is supplied from the washing nozzle 24 </ b> A by performing a water supply operation with a hand operation or a foot switch. It is possible to remove foreign matters such as burns attached to the tip 31a by the water pressure at the time of cleaning.

  Even with the above-described configuration, the operator can selectively remove the knife portion of the treatment tool to which foreign objects such as scorch adhere from the endoscope without removing the knife portion from the endoscope, and continue the treatment. Can be done. Furthermore, compared with the configuration of FIGS. 16 and 17, the cleaning nozzle 24 </ b> A is commonly used for two cleaning operations, the cleaning of the observation window 21 and the cleaning of the treatment instrument 31. There is also an effect to connect.

  20 and 21 show a third embodiment in which a front water supply port capable of supplying water toward the treatment instrument opening of the treatment instrument insertion channel is provided in the distal end section 11 in order to remove scorching at the distal end section of the treatment instrument. An example is shown.

FIG. 20 is a configuration diagram of the distal end surface 11 a 3 of the distal end portion 11 of the insertion portion 2. FIG. 20 shows the configuration of the distal end surface when the distal end surface of the distal end portion of the insertion portion 2 is viewed in plan. As shown in FIG. 20, the distal end surface 11a3 of the distal end portion 11 is provided with an observation window 21, illumination windows 22 and 23, a cleaning nozzle 24, and a treatment instrument opening 25, and a front water supply port 102 is also provided. Is provided.
The front water supply port 102 is provided to supply water to a subject in the observation field in order to wash away foreign matters such as blood adhering to the subject being observed.

FIG. 21 is a partial cross-sectional view of the distal end portion 11 of the insertion portion 2 of the endoscope 1 taken along line XXI-XXI in FIG.
As shown in FIG. 20, the observation window 21, the treatment instrument opening 25, and the front water supply port 102 are laid out in a substantially straight line in this order, and the axial center L2 of the treatment instrument insertion channel 25a communicating with the treatment instrument opening 25 and the front The water supply direction L3 intersects within the observation visual field range, and the water supply direction L3 of the forward water supply intersects the observation center axis L4 within the depth of field. The hole of the front water supply port 102 is formed so as to be inclined toward the treatment instrument opening 25 side so as to have such a configuration.

  When the distal end portion 31a of the treatment instrument 31 protrudes from the distal end surface 11a3, water is supplied from the front water supply port 102 by performing a water supply operation with a hand operation or a foot switch, and the scorching adhered to the distal end portion 31a by the water pressure. Etc. can be removed.

  Even with the above-described configuration, the surgeon can selectively use the forward water supply in the operation at hand without once removing the knife portion of the treatment tool to which foreign matters such as burns are attached from the endoscope. Remove and continue treatment. In addition, the surgeon can confirm the removal state of burned-out foreign substances within the observation field of view, and can reliably supply water to the target affected area within the observation field even during forward water supply operations when there is no treatment tool. become.

FIGS. 22-24 shows the 4th example using the forward water supply function in order to remove the burning of the front-end | tip part of a treatment tool.
FIG. 22 is a partial cross-sectional view of the treatment instrument insertion channel and the front water supply conduit at the distal end portion 11 of the insertion portion 2. FIG. 23 is a partial cross-sectional view showing a state where the treatment instrument is inserted through the treatment instrument insertion channel in FIG. 22. A front water supply port 103 is provided on the distal end surface 11 a 4 of the distal end portion 11. As shown in FIGS. 22 and 23, the treatment instrument insertion channel 25a and the forward water supply conduit 103a for forward water supply run in parallel in the insertion portion 2, and further, in the distal end portion 11 of the insertion portion 2. Is provided with a branch conduit 103b that branches from the front water supply conduit 103a and communicates with the treatment instrument insertion channel 25a. That is, the water in the forward water supply conduit 103a is sent to the forward water supply port 103 via the forward water supply side conduit 103c and is also sent to the treatment instrument insertion channel 25a via the branch conduit 103b. Yes.

  With the distal end portion 31a of the treatment instrument 31 protruding from the distal end surface 11a4, the water in the front water supply conduit 103a is supplied via the front water supply side conduit 103c by performing a water supply operation with a hand operation or a foot switch. While being sent to the front water supply port 103, it is also sent to the treatment instrument insertion channel 25a via the branch pipe 103b. The water W sent to the treatment instrument insertion channel 25a hits the treatment instrument 31 and flows along the treatment instrument 31 to the distal end portion 31a. The water pressure can remove foreign matters such as burns attached to the tip 31a.

  Even with the above-described configuration, the surgeon can selectively use the forward water supply in the operation at hand without once removing the knife portion of the treatment tool to which foreign matters such as burns are attached from the endoscope. Remove and continue treatment.

  It should be noted that a switching valve is provided in the water supply conduit 103a so that when the treatment instrument 31 is cleaned, the water in the front water supply conduit 103a is sent only to the treatment instrument insertion channel 25a via the branch conduit 103b. Good. FIG. 24 is a partial cross-sectional view of the front water supply pipe 103a at the tip 11 for explaining the switching valve 104 provided in the front water supply pipe 103a. As shown in FIG. 24, the switching valve 104 is provided in the branch part of the forward water supply pipe line 103a. When performing forward water supply via the forward water supply side conduit 103c, the switching valve 104 is in a position indicated by a dotted line, and when performing cleaning of the distal end portion 31a of the treatment instrument 31, the switching valve 104 is indicated by a solid line. Switch to position. The switching of the switching valve 104 can be switched by an operation unit at hand of the operator.

  By providing such a switching valve 104 at the branch portion of the forward water supply conduit 103a, the surgeon can selectively supply water in the intended water supply direction, and selectively selects forward water supply and water supply for scorching removal. It becomes possible to do.

FIG. 25 shows a fifth example in which a soft forward water supply conduit is used to remove scorching at the distal end of the treatment instrument.
FIG. 25 is a partial cross-sectional view showing a cross section of only the treatment instrument insertion channel and the front water supply conduit at the distal end portion 11 of the insertion portion 2. A flexible front water supply tube 105 is provided in the insertion portion 2 so as to be able to project and retract from the distal end surface 11 a of the distal end portion 11. The distal end portion of the bending operation wire 106 is fixed to the distal end portion of the forward water supply tube 105. The distal end portion of the wire 106 is fixed on the treatment instrument opening 25 side of the distal end portion of the front water supply tube 105. The wire 106 is configured to be retractable toward the proximal end side along the axial direction of the insertion portion 2, and the operation portion 3 can perform the retraction operation.

  Therefore, when the surgeon performs the cleaning of the distal end portion 31a of the treatment instrument 31, if the wire 106 is operated and pulled to the proximal end side, the distal end portion of the front water supply tube 105 bends in the direction indicated by the arrow, and the treatment instrument Since it is directed to the tip 31a side of 31, the water W hits the tip 31a and can be cleaned.

FIG. 26 shows a sixth example in which water is supplied from the distal end portion of the treatment instrument in order to remove scorching from the distal end portion of the treatment instrument.
FIG. 26 is a partial cross-sectional view of the distal end portion 11 when the distal end portion 31a1 of the treatment instrument 31A protrudes from the treatment instrument opening 25 of the distal end portion 11 of the insertion portion 2. The distal end portion 31a1 of the treatment instrument 31A includes an electrode 107 having a cylindrical portion and a hemispherical distal tip 108. The convex side of the hemispherical tip 108 is connected to the tip side, and the bottom side of the hemispherical tip 108 is connected to the tip of the electrode 107. The electrode 107 extends to the bottom surface of the tip tip 108. In particular, foreign matter is likely to adhere to the electrode on the bottom surface side of the tip 108.

  An electrode energizing wire 109 passes through the treatment instrument 31 </ b> A and is connected to the electrode 107 at the connection portion 110. The electrode 107 is supported in the treatment instrument 31 </ b> A together with the connecting portion 110.

  The base end portion of the cylindrical electrode 107 is connected to the water supply tube 111 at the connection portion 110, and the water flowing through the water supply tube 111 passes through the cylindrical electrode 107 to form a hemispherical tip. It is configured to flow also to the flow path 108 a in the line 108. The flow path 108a is branched into a plurality of portions in the tip tip 108 and communicates with a plurality of openings provided in the bottom surface portion of the tip tip 108.

  Therefore, when the surgeon cleans the distal end portion 31a1 of the treatment instrument 31A, water is supplied from the water supply tube 111 to the distal tip 108, and water W is released from a plurality of openings provided in the bottom surface portion of the distal tip 108. Then, the water W pushes out the foreign matter adhering to the bottom surface portion and hits the electrode 107 for cleaning.

Next, various methods for physically removing the foreign material at the distal end of the treatment tool will be described.
FIG. 27 is a view for explaining a configuration in which the distal end portion of the treatment instrument protruding from the treatment instrument opening is removed with a brush in order to remove the scorching of the distal end portion of the treatment instrument.

  As shown in FIG. 27, the tip end portion 11 is provided with a brush insertion conduit 112, and a line member 113 having a brush 114 at the tip can be inserted into the brush insertion conduit 112. . The wire member 113 and the brush 114 have elasticity. Further, the distal end side of the brush insertion conduit 112 is formed to bend toward the treatment instrument opening 25 side.

  In the treatment tool 31B of FIG. 27, the distal end portion 31a2 includes an electrode 107 having a cylindrical portion and a hemispherical distal tip 108. Further, the line member 113 can protrude and retract from the distal end surface 11a by an operation by a prescriber in the operation unit 3.

  Therefore, when a foreign object adheres to the distal end portion 31a2 of the treatment instrument 31B, the surgeon moves the line member 113 arranged in the brush insertion conduit 112 to the distal end portion 11 side, so that the brush 114 is treated. Foreign matter can be removed by projecting toward the tip 31a2 of the tool 31B and rubbing the brush 114 against the electrode 107.

  FIGS. 28 to 30 show the removal of the distal end of the treatment instrument protruding from the treatment instrument opening by the elastic foreign substance removing member provided in the treatment instrument opening 25 in order to remove scorching of the distal end of the treatment instrument. It is a figure for demonstrating the structure to perform.

  FIG. 28 is a partial cross-sectional view of the treatment instrument opening 25 at the distal end portion 11 of the insertion portion 2. A cylindrical foreign substance removing member 115 is fixedly provided in the treatment instrument opening 25. The foreign substance removing member 115 having elasticity is an elastic member such as rubber or sponge. The inner diameter of the cylindrical foreign matter removing member 115 is smaller than the outer diameter of the distal tip 108 of the treatment tool 31B.

  FIG. 29 is a partial cross-sectional view of the treatment instrument opening 25 of the distal end portion 11 of the insertion portion 2 when the distal end portion 31a2 of the treatment instrument 31B protrudes from the treatment instrument opening portion 25. The treatment tool 31B can perform treatment with the distal end portion 31a2 in a state in which the inner diameter of the foreign substance removal member 115 is expanded.

FIG. 30 is a partial cross-sectional view of the treatment instrument opening 25 of the distal end portion 11 of the insertion portion 2 when a foreign substance attached to the distal end portion of the treatment instrument 31B is removed.
When a foreign substance adheres to the distal end of the treatment portion 31B, the surgeon moves the bottom surface side of the distal tip 108 to the position where the inner diameter of the foreign substance removing member 115 is reduced, as shown in FIG. Pull in the base end. In the state of FIG. 30, the bottom surface side of the tip 108 is in contact with the foreign matter removing member 115. Therefore, the operator can remove the foreign matter by rubbing the electrode 107 and the foreign matter removing member 115 by rotating the treatment tool 31B around the axis in the state of FIG. The foreign matter removing member 115 may be a brush-like member instead of the elastic member.
Furthermore, since the foreign substance removing member 115 is provided in the treatment instrument opening 25, as shown in FIG. 29, the treatment instrument 31B can be prevented from wobbling.

Next, a device for reducing the diameter of the endoscope will be described.
First, the device for the channel tube for the treatment instrument insertion channel will be described.
FIG.31 and FIG.32 is a fragmentary sectional view of the front-end | tip part 11 of the insertion part 2 which shows the channel tube for a treatment tool penetration channel. The treatment instrument insertion channel 25 a is formed by a channel pipe 121 provided in the treatment instrument opening 25 and a channel tube 122 attached to the base end portion of the channel pipe 121.

  The channel pipe 121 is fixed to the distal end portion 11. The base end portion of the channel pipe 121 has a slightly larger outer diameter, and serves as a retaining flange portion 121a for preventing the channel tube 122 from coming off. The channel tube 122 covers the proximal end portion of the channel pipe 121 so as to be caught by the retaining flange portion 121a. For this reason, the outer diameter of the channel tube 122 around the flange portion 121a for retaining the channel pipe 121 is also increased.

The insertion portion 2 of the endoscope 1 is desired to have a small diameter. Therefore, as shown in FIGS. 31 and 32, the periphery of the portion where the outer diameter of the channel tube 122 is large is cut away. In FIG. 31 and FIG. 32, the part shown with a dotted line is shaved.
As a result, the outer diameter portion of the channel tube 122 is thinned only at the connection portion with the channel pipe 121.

  The channel pipe 121 and the channel tube 122 are fixed by an adhesive, and are further firmly fixed by a thread winding portion 123 from above. Only the outer diameter side that does not affect the fixing force is scraped off while securing the adhesive surface as in the conventional case. In a model that can ensure adhesive strength, as shown in FIG. 32, the thread winding portion 123 may be omitted, and the channel tube may be further thinned by eliminating the thread.

  Therefore, the diameter of the insertion portion 2 of the endoscope 1 can be reduced, and interference with other built-in objects can be avoided when the distal end portion 11 is assembled.

Next, a device for preventing perforation of the channel tube will be described.
Here, the thickness of the channel tube for the treatment instrument insertion channel 25a is not uniform in the circumferential direction, and the channel tube has a partially thick portion. Then, when assembling the distal end portion 11, the position of the channel tube around the axis is adjusted so that the thick side of the channel tube has the larger bending radius when the bending portion 12 is bent. 2 is assembled.

  FIG. 33 is a cross-sectional view for explaining the configuration of the channel tube 122. As shown in FIG. 33, the thickness of the channel tube 122 differs in the circumferential direction. As shown in FIG. 33, the thickness d1 on one side of the channel tube 122 is larger than the thickness d2 on the other side. FIG. 34 is a diagram for explaining the state of the treatment tool 31C that travels in the channel tube 122 when the bending operation is performed.

For example, when the treatment tool 31C is advanced and retracted in a state where the bending operation is performed, the treatment tool 31C travels in the bending portion 12 on the side with the larger bending radius in the channel tube 122. In a place where the bending starts in the bending portion 12 or a place where the bending radius is small, as shown in FIG. 34, after the distal end of the treatment tool 31C comes into contact with the inner wall of the channel tube 122 on the side where the bending radius is large, The treatment instrument 31C travels along the inner wall of the channel tube 122 on the side with the larger curvature radius. Therefore, in the bending part 12, contact with the front-end | tip of 31 C of treatment tools and the inner wall of the channel tube 122 is repeated, the channel tube 122 is shaved and thickness becomes thin.
In addition, the bending angle of the bending portion 12 of the insertion portion 2 is different for each endoscope depending on the use of the endoscope, and there are models that have different bending angles in the vertical direction and the horizontal direction. .

  Therefore, here, in an endoscope having a different bending angle, when assembling the distal end portion so that the thickness of the channel tube 122 on the side with the larger bending radius in the bending portion 12 is increased, The channel tube 122 is disposed in the insertion portion 2. As a result, when the bending portion 12 is bent, the distal end of the treatment instrument 31C comes into contact with the thick inner wall located on the side where the bending radius is large, so that the use period until the channel tube 122 is perforated is reached. Can be made longer than before.

Next, a device for improving the assembling property of each built-in object to the distal end hard portion in the distal end portion will be described.
In the present device, a notch 123a is formed in a part of the hole of the insertion portion at the tip of the light guide 22a (or 23a) of the hard tip member 123. The notch 123a is a part of the hole of the built-in object insertion part that is cut out so that the tip of the light guide 22a can be inserted obliquely. FIG. 35 is a cross-sectional view of the distal end portion 11. FIG. 36 is a view for explaining a state in which the light guide 22a is assembled in the distal end hard member.

As shown in FIG. 36, the front end portion of the light guide 22a can be inserted into the hole of the insertion portion from an oblique direction, not parallel to the axial direction of the insertion portion 2 by the notch portion 123a. Therefore, when assembling the distal end portion of the light guide 22a to the distal end rigid member 123, interference with other built-in objects can be avoided, and assemblability is improved.
Since the screws for fixing the light guide 22a are pushed in along the direction orthogonal to the paper surface of FIG. 35 so as to avoid the notch 123a, the fixing with the screws or the like can be surely performed. it can.
Further, here, the light guide 22a is taken as an example of the built-in object, and the assembly of the tip end portion of the light guide 22a to the distal end hard member 123 has been described. However, the present invention is similarly applied to other built-in objects. Is possible.

  The present invention is not limited to the above-described embodiments, and various changes and modifications can be made without departing from the scope of the present invention.

DESCRIPTION OF SYMBOLS 1 Endoscope, 2 insertion part, 3 operation part, 4 universal cable, 11 front-end | tip part, 11a, 11a1, 11a2, 11a3, 11a4 front-end | tip surface, 11b, 11b1 front-end | tip cover, 11c bobbin part, 11d sheath, 11e For guide wires Channel, 11f distal end rigid member, 12 bending portion, 13 flexible tube portion, 14 operation portion main body, 15 bending prevention portion, 16 opening portion, 17 bending operation knob, 18 switches, 21 observation window, 21a imaging unit, 22, 23 Illumination window, 22a, 23a Light guide, 24 Cleaning nozzle, 25 Treatment tool opening, 25a Treatment tool insertion channel, 25A Space part, 26, 26A, 26D Foreign object removal surface, 26a Convex part, 26B Inclined surface, 26b Step part 26b1 Edge portion, 26C, 26E Foreign matter removal portion, 26c Projection portion, 31, 1A, 31B, 31C Treatment tool, 31a, 31a1, 31a2 Treatment tool tip, 31b Sheath part, 41 Endoscopic image, 51 Pressing mechanism, 52 Guide wire, 53 Movable member, 53a Small diameter part, 54 Guide table, 54a Press part, 54b Engagement part, 55 Shaft member, 101 Foreign matter removal water supply nozzle, 101a Water supply pipe, 102 Front water supply, 103 Front water supply, 103a Front water supply, 103b Branch pipe, 103c Front water supply Pipe line, 104 switching valve, 105 forward water supply tube, 106 wire, 107 electrode, 108 tip, 108a flow path, 109 conducting wire, 110 connection part, 111 water supply tube, 112 brass insertion channel, 113 wire member, 114 brush 115 Foreign matter removing member, 121 channel pipe, 121a Retaining flange part, 122 channel tube, 123 thread winding part, 123a Notch part

Claims (9)

In an endoscope having an opening at the distal end portion of the insertion portion having at least an imaging portion, and having a channel that communicates with the opening and allows a treatment tool to be inserted and removed,
An endoscope having a foreign matter removing portion for removing foreign matter attached to the treatment instrument at least at a part of an opening edge portion of the opening portion.   The endoscope according to claim 1, wherein the foreign substance removing unit is provided on a part of the opening edge portion on the objective window side for the imaging unit.   The endoscope according to claim 1, wherein the foreign substance removing portion is provided over the entire circumference of the opening edge portion.   The said foreign substance removal part is an uneven | corrugated surface provided in the front-end | tip part of the said insertion part, and inclined with respect to the insertion / extraction direction of the said treatment tool, The one of Claim 1 characterized by the above-mentioned. Endoscope.   The said foreign substance removal part is 1 or 2 or more convex parts provided in the inclined surface of the front-end | tip part of the said insertion part inclined with respect to the insertion / extraction direction of the said treatment tool. The endoscope according to any one of the above.   The endoscope according to claim 5, wherein the convex portion has a blade shape.   The foreign matter removing portion is formed at a boundary portion between an inclined surface inclined with respect to the insertion / extraction direction of the treatment instrument provided at a distal end portion of the insertion portion and an inner wall surface of a treatment instrument insertion channel communicating with the opening. The endoscope according to claim 1, wherein the endoscope is an edge portion.   The foreign matter removing portion is provided in a protruding portion protruding from the tip portion, and the protruding portion is lower than a plane including a tangent line between a cleaning nozzle provided in the tip portion and an outer peripheral portion of the tip portion. The endoscope according to claim 1, wherein:   The endoscope according to claim 1, further comprising a pressing structure that presses the treatment tool against the foreign substance removing unit.

Images