JP2013248346A

JP2013248346A - Endoscope system

Info

Publication number: JP2013248346A
Application number: JP2012127342A
Authority: JP
Inventors: Suguru Okaniwa; 傑岡庭
Original assignee: Olympus Medical Systems Corp
Current assignee: Olympus Medical Systems Corp
Priority date: 2012-06-04
Filing date: 2012-06-04
Publication date: 2013-12-12
Anticipated expiration: 2032-06-04
Also published as: JP5810037B2

Abstract

PROBLEM TO BE SOLVED: To provide an endoscope system for preventing breakage of an active type bend part, easily straightening a body cavity, and improving insertability to the body cavity, in the endoscope system including an endoscope having the active type bend part and a passive type bend part and an insertion aid for the endoscope.SOLUTION: An endoscope system 1 includes: an endoscope 2 having a first bend part 7 provided on an insertion part 10 to be inserted into a body cavity, to be actively bent, a second bend part 8 to be passively bent by external force, and a projection part 50 provided on a boundary part of the first bend part 7 and the second bend part 8 and projected and formed around an outer circumference; and an insertion aid 60 for the endoscope, having a flexible tube 62 to which the insertion part 10 is freely inserted, and a ring-like hood 61 provided on the distal end of the flexible tube 62 and formed from an elastic member having an opening diameter D2 smaller than the outer diameter d1 of the projection part 50.

Description

本発明は、能動型の湾曲部と受動型の湾曲部を備えた内視鏡および体腔への内視鏡の挿入を補助する内視鏡用挿入補助具を有した内視鏡システムに関する。 The present invention relates to an endoscope system including an endoscope having an active bending portion and a passive bending portion, and an endoscope insertion assisting tool for assisting insertion of the endoscope into a body cavity.

周知の如く、内視鏡は、生体の体内（体腔内）の観察、処置など、または工業用のプラント設備内の検査、修理などのため広く用いられている。特に、医療用の内視鏡は、細長の挿入部を体腔内に挿入することにより、切開を必要とすることなく、体腔内の検査対象部位を観察でき、必要に応じ、処置具を用いて治療処置できるため広く用いられるようになった。この医療分野の内視鏡は、患者の体腔への挿入性を向上させるため、例えば、特許文献１に能動型の湾曲部と外力を受けると容易に湾曲する受動型の湾曲部を備えた内視鏡が開示されている。このような医療用の内視鏡は、体腔への挿入部の挿入過程において、例えば、挿入部を捻り操作、牽引操作などして体腔を直線化しながら挿入する操作が行なわれることがある。 As is well known, endoscopes are widely used for observation and treatment of living bodies (inside body cavities), inspections and repairs in industrial plant facilities, and the like. In particular, medical endoscopes can observe a region to be examined in a body cavity by inserting an elongated insertion portion into the body cavity without requiring an incision. Since it can be treated, it has become widely used. In order to improve the insertion into a patient's body cavity, an endoscope in this medical field is provided with, for example, an active bending portion and an internal bending portion that is easily bent when external force is applied. An endoscope is disclosed. In such a medical endoscope, in the process of inserting the insertion portion into the body cavity, for example, an operation of inserting the insertion portion while straightening the body cavity by twisting or pulling the insertion portion may be performed.

また、内視鏡用挿入補助具である内視鏡用オーバーチューブを用いて体腔の屈曲部に内視鏡の挿入部を挿入し易くする技術がある。この内視鏡用オーバーチューブを例えば内視鏡と共に体腔内に挿入することにより、体腔内への内視鏡の挿入経路が確保されて、その後の内視鏡の挿抜が容易になる。このような内視鏡用オーバーチューブの技術は、例えば、特許文献２に開示されている。 In addition, there is a technique that makes it easy to insert an insertion portion of an endoscope into a bending portion of a body cavity using an endoscope overtube that is an insertion aid for an endoscope. By inserting the endoscope overtube into the body cavity together with the endoscope, for example, an insertion path of the endoscope into the body cavity is secured, and subsequent insertion / removal of the endoscope becomes easy. The technique of such an endoscope overtube is disclosed in, for example, Patent Document 2.

ところで、特許文献１に開示されるような受動型の湾曲部を備えた従来の内視鏡では、受動型の湾曲部が長いと、この受動型の湾曲部の湾曲によってコシ砕け易く、挿入部先端が体腔の屈曲部に引っ掛かり難くなってしまい、体腔を直線化し難いという問題がある。その一方、内視鏡は、挿入部を体腔へ押し込むときには、受動型の湾曲部を設けたほうが挿入部の挿入性が向上する。そのため、従来では、体腔への最適な挿入操作を行なえるように、特許文献１の内視鏡と特許文献２の内視鏡用オーバーチューブを併用することが考えられる。 By the way, in the conventional endoscope provided with the passive-type bending portion as disclosed in Patent Document 1, if the passive-type bending portion is long, the insertion portion is easily broken due to the bending of the passive-type bending portion. There is a problem that it is difficult for the distal end to be caught by the bent part of the body cavity and it is difficult to straighten the body cavity. On the other hand, in the endoscope, when the insertion portion is pushed into the body cavity, the insertion property of the insertion portion is improved by providing the passive bending portion. Therefore, conventionally, it is conceivable to use the endoscope of Patent Document 1 and the endoscope overtube of Patent Document 2 in combination so that an optimal insertion operation into a body cavity can be performed.

特開２００７−５４４００号公報JP 2007-54400 A 特開２０００−２６２４６５号公報JP 2000-262465 A

しかしながら、従来の内視鏡の挿入部を従来の内視鏡用オーバーチューブに挿入して併用するとき、内視鏡用オーバーチューブが挿入部の能動型の湾曲部まで覆ってしまうと、能動型の湾曲部の湾曲操作が行い難く、挿入部先端を体腔の屈曲部に引っ掛け難くなり、かえって体腔を直線化し難くなるという問題があった。また、内視鏡用オーバーチューブが挿入部の能動型の湾曲部を覆った状態で、湾曲操作を行うと、能動型の湾曲部に無理な負荷がかかり、能動型の湾曲部が破損する虞もある。 However, when the insertion portion of the conventional endoscope is inserted into the conventional endoscope overtube and used together, if the endoscope overtube covers the active bending portion of the insertion portion, the active type There is a problem that it is difficult to perform the bending operation of the bending portion, and it is difficult to hook the distal end of the insertion portion to the bending portion of the body cavity, and it is difficult to linearize the body cavity. Further, if the bending operation is performed with the endoscope overtube covering the active bending portion of the insertion portion, an excessive load is applied to the active bending portion, and the active bending portion may be damaged. There is also.

そこで、本発明は、上記事情に鑑みてなされたものであり、能動型の湾曲部および受動型の湾曲部を備えた内視鏡と内視鏡用挿入補助具を備えた内視鏡システムにおいて、能動型の湾曲部の破損を防止すると共に、体腔の直線化を容易に行えるようにして、体腔への挿入性が向上する内視鏡システムを提供することを目的とする。 Therefore, the present invention has been made in view of the above circumstances, and in an endoscope system including an endoscope including an active bending portion and a passive bending portion, and an endoscope insertion aid. An object of the present invention is to provide an endoscope system that prevents breakage of an active bending portion and facilitates straightening of a body cavity, thereby improving insertion into the body cavity.

本発明における一態様の内視鏡システムは、体腔内に挿入される挿入部と、前記挿入部に設けられ、湾曲操作されて能動的に湾曲する第１の湾曲部と、前記第１の湾曲部に連設され、外力により受動的に湾曲する第２の湾曲部と、前記第１の湾曲部と前記第２の湾曲部との境界部分に設けられ、外周回りに突起形成された凸部と、を備えた内視鏡と、前記挿入部が挿通自在な可撓性チューブと、前記可撓性チューブの先端に設けられ、前記凸部の外径よりも小さな開口径を有する弾性部材から形成された円環状のフードと、を備えた内視鏡用挿入補助具と、を具備する。 An endoscope system according to an aspect of the present invention includes an insertion portion that is inserted into a body cavity, a first bending portion that is provided in the insertion portion and is actively bent by a bending operation, and the first bending A second bending portion that is connected to the portion and is passively bent by an external force, and a convex portion that is provided at a boundary portion between the first bending portion and the second bending portion, and is formed to protrude around the outer periphery. And a flexible tube through which the insertion portion can be inserted, and an elastic member provided at the distal end of the flexible tube and having an opening diameter smaller than the outer diameter of the convex portion. An endoscope insertion aid having a formed annular hood.

本発明によれば、能動型の湾曲部および受動型の湾曲部を備えた内視鏡と内視鏡用挿入補助具を備えた内視鏡システムにおいて、能動型の湾曲部の破損を防止すると共に、体腔の直線化を容易に行えるようにして、体腔への挿入性が向上する内視鏡システムを提供できる。 According to the present invention, in an endoscope system including an endoscope having an active bending portion and a passive bending portion and an insertion assisting tool for an endoscope, the active bending portion is prevented from being damaged. At the same time, it is possible to provide an endoscope system that facilitates straightening of the body cavity and improves insertability into the body cavity.

本発明の一態様の内視鏡システムの全体構成図1 is an overall configuration diagram of an endoscope system according to an aspect of the present invention. 同、挿入部の構成を示す図The figure which shows the structure of an insertion part similarly 同、挿入部の構成を示す断面図Sectional drawing which shows the structure of an insertion part similarly 同、変形例の挿入部の構成を示す断面図Sectional drawing which shows the structure of the insertion part of a modification same as the above 同、内視鏡用オーバーチューブの構成を示す部分断面図Partial sectional view showing the configuration of the endoscope overtube 同、内視鏡用オーバーチューブに挿入部が挿入された状態を示す部分断面図The same fragmentary sectional view which shows the state where the insertion part was inserted in the overtube for endoscope 同、挿入部が脾湾曲部まで挿入された状態を示す図The figure which shows the state by which the insertion part was inserted to the spleen curved part similarly 同、脾湾曲部まで挿入された挿入部の第１の湾曲部が湾曲操作された状態を示す図The figure which shows the state by which the 1st bending part of the insertion part inserted to the spleen bending part was bent similarly 同、脾湾曲部まで挿入された挿入部に沿って内視鏡用オーバーチューブが押し込まれた状態を示す図The figure which shows the state by which the overtube for endoscopes was pushed in along the insertion part inserted to the spleen curved part same as the above 同、内視鏡用オーバーチューブのフードが挿入部の凸部に突き当たった状態を示す図The figure which shows the state which the hood of the overtube for endoscopes hit | butted the convex part of the insertion part similarly 同、挿入部が第２の湾曲部により脾湾曲部に引掛け難い状態を説明する図The figure explaining the state in which an insertion part is hard to be hooked on a spleen curved part by a 2nd curved part similarly 同、挿入部および内視鏡用オーバーチューブの捻り操作および牽引操作によってＳ状結腸および下行結腸が直線化された状態を示す図The figure which shows the state by which the sigmoid colon and the descending colon were linearized by twisting operation and pulling operation of the insertion part and the overtube for endoscopes 同、挿入部が肝湾曲部まで挿入された状態を示す図The figure which shows the state by which the insertion part was inserted to the liver bending part similarly 同、肝湾曲部まで挿入された挿入部に沿って内視鏡用オーバーチューブが押し込まれた状態を示す図The figure which shows the state by which the overtube for endoscopes was pushed in along the insertion part inserted to the liver curved part same as the above 同、挿入部および内視鏡用オーバーチューブの捻り操作および牽引操作によって横行結腸が直線化された状態を示す図The figure which shows the state by which the transverse colon was linearized by twisting operation of the insertion part and the overtube for endoscopes, and pulling operation 同、挿入部が大腸深部まで挿入された状態を示す図The figure which shows the state in which the insertion part was inserted to the large intestine deep part similarly 同、第１の変形例の内視鏡用オーバーチューブの構成を示す部分断面図The fragmentary sectional view which shows the structure of the overtube for endoscopes of a 1st modification same as the above 同、第２の変形例の内視鏡用オーバーチューブの構成を示す部分断面図The fragmentary sectional view which shows the structure of the overtube for endoscopes of a 2nd modification same as the above 同、図１８のＸＩＸ−ＸＩＸ線断面図FIG. 18 is a cross-sectional view taken along line XIX-XIX in FIG.

以下、本発明である内視鏡システムについて説明する。なお、以下の説明において、各実施の形態に基づく図面は、模式的なものであり、各部分の厚みと幅との関係、夫々の部分の厚みの比率などは現実のものとは異なることに留意すべきであり、図面の相互間においても互いの寸法の関係や比率が異なる部分が含まれている場合がある。 Hereinafter, an endoscope system according to the present invention will be described. In the following description, the drawings based on each embodiment are schematic, and the relationship between the thickness and width of each part, the thickness ratio of each part, and the like are different from the actual ones. It should be noted that the drawings may include portions having different dimensional relationships and ratios between the drawings.

先ず、図面に基づいて本発明の実施の形態を説明する。図１から図１９は本発明に係り、図１は内視鏡システムの全体構成図、図２は挿入部の構成を示す図、図３は挿入部の構成を示す断面図、図４は変形例の挿入部の構成を示す断面図、図５は内視鏡用オーバーチューブの構成を示す部分断面図、図６は内視鏡用オーバーチューブに挿入部が挿入された状態を示す部分断面図、図７は挿入部が脾湾曲部まで挿入された状態を示す図、図８は脾湾曲部まで挿入された挿入部の第１の湾曲部が湾曲操作された状態を示す図、図９は脾湾曲部まで挿入された挿入部に沿って内視鏡用オーバーチューブが押し込まれた状態を示す図、図１０は内視鏡用オーバーチューブのフードが挿入部の凸部に突き当たった状態を示す図、図１１は挿入部が第２の湾曲部により脾湾曲部に引掛け難い状態を説明する図、図１２は挿入部および内視鏡用オーバーチューブの捻り操作および牽引操作によってＳ状結腸および下行結腸が直線化された状態を示す図、図１３は挿入部が肝湾曲部まで挿入された状態を示す図、図１４は肝湾曲部まで挿入された挿入部に沿って内視鏡用オーバーチューブが押し込まれた状態を示す図、図１５は挿入部および内視鏡用オーバーチューブの捻り操作および牽引操作によって横行結腸が直線化された状態を示す図、図１６は挿入部が大腸深部まで挿入された状態を示す図、図１７は第１の変形例の内視鏡用オーバーチューブの構成を示す部分断面図、図１８は第２の変形例の内視鏡用オーバーチューブの構成を示す部分断面図、図１９は図１８のＸＩＸ−ＸＩＸ線断面図である。 First, an embodiment of the present invention will be described based on the drawings. 1 to 19 relate to the present invention, FIG. 1 is an overall configuration diagram of an endoscope system, FIG. 2 is a diagram showing a configuration of an insertion portion, FIG. 3 is a sectional view showing a configuration of the insertion portion, and FIG. FIG. 5 is a partial cross-sectional view showing a configuration of an endoscope overtube, and FIG. 6 is a partial cross-sectional view showing a state in which the insert portion is inserted into the endoscope overtube. 7 is a view showing a state where the insertion portion is inserted up to the spleen bending portion, FIG. 8 is a view showing a state where the first bending portion of the insertion portion inserted up to the splenic bending portion is bent, and FIG. The figure which shows the state by which the overtube for endoscopes was pushed in along the insertion part inserted to the spleen curved part, FIG. 10 shows the state in which the food | hood of the overtube for endoscopes bumped into the convex part of the insertion part FIG. 11 is a diagram for explaining a state in which the insertion portion is difficult to be hooked on the spleen curved portion by the second curved portion; 12 is a view showing a state in which the sigmoid colon and descending colon are linearized by twisting and pulling operations of the insertion portion and the endoscope overtube, and FIG. 13 shows a state in which the insertion portion is inserted to the liver bending portion. 14 and 14 are views showing a state where the endoscope overtube is pushed along the insertion portion inserted up to the liver bending portion, and FIG. 15 is a twisting operation and a traction operation of the insertion portion and the endoscope overtube. FIG. 16 is a diagram showing a state in which the transverse colon is linearized by FIG. 16, FIG. 16 is a diagram showing a state in which the insertion portion is inserted deep into the large intestine, and FIG. 17 is a portion showing the configuration of the endoscope overtube of the first modification FIG. 18 is a partial cross-sectional view showing a configuration of an endoscope overtube according to a second modification, and FIG. 19 is a cross-sectional view taken along line XIX-XIX in FIG.

図１に示すように、本実施の形態の内視鏡システム１は、内視鏡２と、光源装置３と、ビデオプロセッサ４と、モニタ５と、内視鏡用挿入補助具である内視鏡用オーバーチューブ６０と、から主に構成されている。 As shown in FIG. 1, an endoscope system 1 according to the present embodiment includes an endoscope 2, a light source device 3, a video processor 4, a monitor 5, and an endoscope that is an endoscope insertion aid. The mirror overtube 60 is mainly configured.

内視鏡２は、長尺で細長な挿入部１０と、操作部１１と、ユニバーサルケーブル１９と、を有して構成されている。内視鏡２の挿入部１０は、先端から順に先端部６と、湾曲部３０と、可撓管部９と、を有して構成されている。更に湾曲部３０は先端側から順に第１の湾曲部７と第２の湾曲部８で構成されている。なお、この挿入部１０の詳細な構成については、後に詳しく説明する。 The endoscope 2 has a long and narrow insertion portion 10, an operation portion 11, and a universal cable 19. The insertion portion 10 of the endoscope 2 includes a distal end portion 6, a bending portion 30, and a flexible tube portion 9 in order from the distal end. Further, the bending portion 30 is composed of a first bending portion 7 and a second bending portion 8 in order from the distal end side. The detailed configuration of the insertion unit 10 will be described in detail later.

また、操作部１１は、折れ止め部から挿入部１０の可撓管部９が延設され、挿入部１０に配設される各種処置具を挿通する後述の処置具チャンネル３９（図３参照）の開口部である処置具チャンネル挿通部１８を有している。 In addition, the operation section 11 includes a treatment instrument channel 39 (see FIG. 3), which will be described later, in which the flexible tube section 9 of the insertion section 10 extends from the bend preventing section and various treatment instruments disposed in the insertion section 10 are inserted. It has a treatment instrument channel insertion portion 18 which is an opening portion.

操作部１１には、挿入部１０の第１の湾曲部７を湾曲操作するための湾曲操作ノブ１４が回動自在に配設されると共に、各種内視鏡機能のスイッチ類１７などが設けられている。なお、湾曲操作ノブ１４は、第１の湾曲部７を上下方向に湾曲操作するためのＵＤ湾曲操作ノブ１２および第１の湾曲部７を左右方向に湾曲操作するためのＲＬ湾曲操作ノブ１３が重畳するように配設されている。また、操作部１１には、挿入部１０の可撓管部９の硬さを可変自在な硬度可変ダイヤル２２が設けられている。 The operation section 11 is provided with a bending operation knob 14 for bending the first bending section 7 of the insertion section 10, and is provided with switches 17 for various endoscope functions. ing. The bending operation knob 14 includes a UD bending operation knob 12 for bending the first bending portion 7 in the up-down direction and an RL bending operation knob 13 for bending the first bending portion 7 in the left-right direction. It arrange | positions so that it may overlap. In addition, the operation portion 11 is provided with a hardness variable dial 22 that can change the hardness of the flexible tube portion 9 of the insertion portion 10.

操作部１１から延設されたユニバーサルケーブル１９は、延出端に光源装置３と着脱自在な内視鏡コネクタ２０を有している。なお、本実施の形態の内視鏡２は、ユニバーサルケーブル１９、操作部１１および挿入部１０に配設された後述する照明手段のライトガイドバンドル３２（図３参照）によって、光源装置３から挿入部１０の先端まで照明光を伝送するものである。また、内視鏡コネクタ２０は、着脱自在なケーブル２１が延設され、このケーブル２１の延出端が電気コネクタによってビデオプロセッサ４に対して着脱自在な構成となっている。 The universal cable 19 extended from the operation unit 11 has an endoscope connector 20 that is detachable from the light source device 3 at the extended end. Note that the endoscope 2 of the present embodiment is inserted from the light source device 3 by the light guide bundle 32 (see FIG. 3) of the illumination means described later disposed on the universal cable 19, the operation unit 11, and the insertion unit 10. The illumination light is transmitted to the tip of the unit 10. The endoscope connector 20 is provided with a detachable cable 21, and the extended end of the cable 21 is detachable from the video processor 4 by an electric connector.

ビデオプロセッサ４は、内視鏡画像を表示するモニタ５と電気的に接続され、内視鏡２の後述する撮像手段である内視鏡用撮像ユニットによって光電変換された撮像信号を信号処理して、画像信号としてモニタ５に出力する。なお、光源装置３には、図示しないが、内視鏡２の挿入部１０の先端部６から空気、及び水を噴出するための送気送水機能が光源装置３に設けられている。 The video processor 4 is electrically connected to a monitor 5 that displays an endoscopic image, and performs signal processing on an imaging signal photoelectrically converted by an endoscope imaging unit that is an imaging unit to be described later of the endoscope 2. , And output to the monitor 5 as an image signal. Although not shown, the light source device 3 is provided with an air / water supply function for ejecting air and water from the distal end portion 6 of the insertion portion 10 of the endoscope 2.

次に、内視鏡２の挿入部１０の構成について、図２および図３に基づいて、以下に説明する。
本実施の形態の挿入部１０は、図２および図３に示すように、硬性の先端部６と、湾曲部３０と、可撓管部９と、を有して構成されている。湾曲部３０は能動的に湾曲操作される第１の湾曲部７と、受動的に湾曲する非常に柔軟な第２の湾曲部８とからなる。可撓管部９は第２の湾曲部８よりも硬度（曲げ剛性）が高く設定されている。なお、第２の湾曲部８は操作部１４によって湾曲操作はできないが、外力を受けることで曲げられる受動型の湾曲部として機能するものである。 Next, the configuration of the insertion portion 10 of the endoscope 2 will be described below based on FIG. 2 and FIG.
As shown in FIGS. 2 and 3, the insertion portion 10 according to the present embodiment is configured to include a rigid distal end portion 6, a bending portion 30, and a flexible tube portion 9. The bending portion 30 includes a first bending portion 7 that is actively bent, and a very flexible second bending portion 8 that is passively bent. The flexible tube portion 9 is set to have a higher hardness (bending rigidity) than the second bending portion 8. The second bending portion 8 cannot be bent by the operation portion 14, but functions as a passive bending portion that is bent by receiving an external force.

この挿入部１０は、能動型の第１の湾曲部７と、受動型の第２の湾曲部８と、の境界部分が外周方向に突起する凸部５０が形成されている。この凸部５０は、第１の湾曲部７および第２の湾曲部８の境界部分に段部が形成されるように、挿入部１０の外周回りに所定の長さを有して突起している。 The insertion portion 10 is formed with a convex portion 50 in which a boundary portion between the active first bending portion 7 and the passive second bending portion 8 protrudes in the outer peripheral direction. The convex portion 50 protrudes with a predetermined length around the outer periphery of the insertion portion 10 so that a step portion is formed at the boundary portion between the first bending portion 7 and the second bending portion 8. Yes.

先端部６は、図３に示すように、金属性ブロックである先端硬質部２３に樹脂性の先端カバー２４が配設されている。この先端部６は、先端カバー２４が設けられた先端面に照明窓としての照明光学系３１が配設され、この照明光学系３１の後方に光源装置３からの照明光を伝送するライトガイドバンドル３２の端部が配置されている。即ち、ライトガイドバンドル３２で伝送された照明光は、先端部６の先端面に配設された照明光学系３１から前方に出射され、患部などの被写体を照明する。 As shown in FIG. 3, the distal end portion 6 is provided with a resinous distal end cover 24 on the distal end hard portion 23 which is a metallic block. The distal end portion 6 is provided with an illumination optical system 31 as an illumination window on the distal end surface on which the distal end cover 24 is provided, and a light guide bundle that transmits illumination light from the light source device 3 behind the illumination optical system 31. 32 ends are arranged. That is, the illumination light transmitted by the light guide bundle 32 is emitted forward from the illumination optical system 31 disposed on the distal end surface of the distal end portion 6 to illuminate a subject such as an affected area.

また、先端部６には、観察窓としての観察光学系である対物レンズ３３およびこの対物レンズ３３の結像位置に設けられて光学像を光電変換する機能を備えた電荷結合素子としての固体撮像素子（ＣＣＤまたはＣＭＯＳなど）３４を備えた撮像ユニット３５が設けられている。なお、撮像ユニット３５からは、通信ケーブル３６が延設されている。 Further, the distal end portion 6 is provided with an objective lens 33 that is an observation optical system as an observation window, and a solid-state imaging as a charge coupled device that is provided at an imaging position of the objective lens 33 and has a function of photoelectrically converting the optical image An imaging unit 35 including an element (CCD or CMOS) 34 is provided. Note that a communication cable 36 is extended from the imaging unit 35.

また、先端部６の先端面には、対物レンズ３３の表面に向けて送気送水する送気送水ノズル３７が設けられている。この送気送水ノズル３７は、送気送水管路３８の一端が接続されている。さらに、先端部６の先端面には、処置具チャンネル３９の開口が設けられている。 Further, an air / water supply nozzle 37 for supplying air / water toward the surface of the objective lens 33 is provided on the distal end surface of the distal end portion 6. One end of an air / water supply conduit 38 is connected to the air / water supply nozzle 37. Furthermore, an opening of the treatment instrument channel 39 is provided at the distal end surface of the distal end portion 6.

先端部６に隣接して設けられた湾曲部３０の一つである第１の湾曲部７は、リング形状の多数の湾曲駒４１が、隣接する湾曲駒４１と上下、左右に対応する位置でリベットなどによって互いに回動自在に連結して構成されている。これら湾曲駒４１の外周には、網状管４５ａが被覆されている。なお、最先端の湾曲駒４１には、湾曲ワイヤ４２の端部が固着されている。この湾曲ワイヤ４２は、挿入部１０内の第２の湾曲部８の先端まで配設されるコイルシース４３内に挿通され、その後端が操作部１１内の図示しないスプロケットに連結されている。 The first bending portion 7, which is one of the bending portions 30 provided adjacent to the distal end portion 6, has a large number of ring-shaped bending pieces 41 at positions corresponding to the adjacent bending pieces 41 in the vertical and horizontal directions. The rivets are connected to each other by rivets or the like so as to be rotatable. The outer periphery of these bending pieces 41 is covered with a mesh tube 45a. Note that the end of the bending wire 42 is fixed to the most advanced bending piece 41. The bending wire 42 is inserted into a coil sheath 43 disposed up to the distal end of the second bending portion 8 in the insertion portion 10, and the rear end is connected to a sprocket (not shown) in the operation portion 11.

このスプロケットは、湾曲操作ノブ１４に連結されている。そして、ＵＤ湾曲操作ノブ１２またはＲＬ湾曲操作ノブ１３を回動する操作を行うことにより、上下方向または左右方向に沿って配置した一対の湾曲ワイヤ４２の一方を牽引し、他方を弛緩させて牽引した湾曲ワイヤ４２側に第１の湾曲部７を湾曲させることができるようにしている。即ち、第１の湾曲部７は、湾曲操作ノブ１４の操作により能動的に湾曲する能動型の湾曲部を構成している。 This sprocket is connected to the bending operation knob 14. Then, by rotating the UD bending operation knob 12 or the RL bending operation knob 13, one of the pair of bending wires 42 arranged along the vertical direction or the horizontal direction is pulled, and the other is relaxed and pulled. The first bending portion 7 can be bent toward the bending wire 42 side. That is, the first bending portion 7 constitutes an active bending portion that is actively bent by the operation of the bending operation knob 14.

また、湾曲部３０の一つである第２の湾曲部８には、螺旋管（フレックス管ともいう）４４と、この螺旋管４４を被覆する網状管（ブレードともいう）４５ｂと、が設けられている。この第２の湾曲部８は、網状管４５ｂの外周が外皮としての軟性管である湾曲ゴム（湾曲ゴム管）４７によって覆われている。 The second bending portion 8 that is one of the bending portions 30 is provided with a spiral tube (also referred to as a flex tube) 44 and a mesh tube (also referred to as a blade) 45b that covers the spiral tube 44. ing. In the second curved portion 8, the outer periphery of the mesh tube 45b is covered with a curved rubber (curved rubber tube) 47 which is a soft tube as an outer skin.

第２の湾曲部８は、螺旋管４４を被覆する網状管４５ｂおよび湾曲ゴム４７の曲げ剛性により、所定の硬さが設定されている。なお、第２の湾曲部８は、後述する可撓管部９よりも所定の硬さが低く設定されており、非常に柔軟な構成となっている。また、この第２の湾曲部８は、外力により受動的に湾曲する受動型の湾曲部を構成している。 The second bending portion 8 has a predetermined hardness set by the bending rigidity of the mesh tube 45 b and the bending rubber 47 covering the spiral tube 44. The second bending portion 8 is set to have a predetermined hardness lower than that of the flexible tube portion 9 described later, and has a very flexible configuration. Further, the second bending portion 8 constitutes a passive bending portion that is passively bent by an external force.

なお、湾曲ゴム４７は、先端部６の先端カバー２４に連設され、先端部６の後方から第１の湾曲部７および第２の湾曲部８を一体的に被覆している。また、湾曲ゴム４７は、先端部分が糸巻き接着部４８によって固着されている。 The curved rubber 47 is connected to the distal end cover 24 of the distal end portion 6 and integrally covers the first curved portion 7 and the second curved portion 8 from the rear of the distal end portion 6. Further, the curved rubber 47 has a tip portion fixed by a bobbin adhering portion 48.

そして、湾曲ゴム４７は、能動型の第１の湾曲部７および受動型の第２の湾曲部８の境界外周部分が上述の凸部５０により外周回りに突起するよう形成される。この凸部５０を形成する構成を具体的に説明すると、ここでは、第１の湾曲部７および第２の湾曲部８の境界外周部分に、最基端の湾曲駒４１と螺旋管４４の先端部分を接続するリング状の口金である連結管５４が設けられている。 The curved rubber 47 is formed so that the boundary outer peripheral portion of the active first bending portion 7 and the passive second bending portion 8 protrudes around the outer periphery by the convex portion 50 described above. The configuration for forming the convex portion 50 will be described in detail. Here, at the boundary outer peripheral portion of the first bending portion 7 and the second bending portion 8, the most proximal bending piece 41 and the distal end of the spiral tube 44 are provided. A connecting pipe 54 that is a ring-shaped base for connecting the portions is provided.

この連結管５４は、螺旋管４４の先端部分が内周側に、最基端の湾曲駒４１が外周側に嵌合されている。また、連結管５４に外嵌する湾曲駒４１の外周部には、網状管４５ａが被覆され、この網状管４５ａは、湾曲駒４１と半田などによるロウ付部５４ａによって固着されている。このように、連結管５４に外嵌する湾曲駒４１の厚さと、網状管４５ａを湾曲駒４１に固着するロウ付部５４ａの厚みによって、外周方向に突起される部分に湾曲ゴム４７が被覆されることで、第１の湾曲部７および第２の湾曲部８の境界外周部分に外周回りに突起する凸部５０が形成される。 In the connecting pipe 54, the distal end portion of the spiral pipe 44 is fitted on the inner peripheral side, and the most proximal bending piece 41 is fitted on the outer peripheral side. The outer periphery of the bending piece 41 fitted around the connecting pipe 54 is covered with a mesh tube 45a, and the mesh tube 45a is fixed to the bending piece 41 with a brazing portion 54a made of solder or the like. As described above, the curved rubber 47 is coated on the portion protruding in the outer peripheral direction by the thickness of the bending piece 41 fitted on the connecting pipe 54 and the thickness of the brazed portion 54a for fixing the mesh tube 45a to the bending piece 41. Thus, a convex portion 50 that protrudes around the outer periphery is formed at the boundary outer peripheral portion of the first bending portion 7 and the second bending portion 8.

可撓管部９には、第２の湾曲部８と同様に、螺旋管５１と、この螺旋管５１を被覆する網状管５２と、が設けられている。この可撓管部９は、網状管５２の外周が外皮としての樹脂管５３によって覆われている。なお、湾曲ゴム４７の基端分と樹脂管５３の先端部分は、糸巻き接着部４９によって固着されている。 Similar to the second bending portion 8, the flexible tube portion 9 is provided with a spiral tube 51 and a mesh tube 52 that covers the spiral tube 51. In the flexible tube portion 9, the outer periphery of the mesh tube 52 is covered with a resin tube 53 as an outer skin. Note that the proximal end portion of the curved rubber 47 and the distal end portion of the resin tube 53 are fixed by a bobbin adhering portion 49.

樹脂管５３は、外周の表面に耐薬性のコーティングが施され、可撓管部９が所定の硬さ（曲げ剛性）となるように、それ自体の硬度が設定されている。即ち、可撓管部９は、樹脂管５３の曲げ剛性により、上述したように第２の湾曲部８よりも所定の硬さが高く設定されており、体腔（ここでは大腸）への押し込み操作に必要な所定の可撓性（所謂コシ）を有した構成となっている。なお、可撓管部９の螺旋管５１および網状管５２は、ここでは、第２の湾曲部８の螺旋管４４および網状管４５ｂと連続する一体的な構成となっている。なお、螺旋管４４，５１および網状管４５ｂ，５２は、第２の湾曲部８および可撓管部９において別体として設けても良い。 The resin tube 53 is coated with a chemical resistant coating on the outer peripheral surface, and its own hardness is set so that the flexible tube portion 9 has a predetermined hardness (bending rigidity). That is, the flexible tube portion 9 is set to have a predetermined hardness higher than that of the second bending portion 8 as described above due to the bending rigidity of the resin tube 53, and is pushed into the body cavity (here, the large intestine). It has a configuration having a predetermined flexibility (so-called stiffness) necessary for the above. Here, the spiral tube 51 and the mesh tube 52 of the flexible tube portion 9 have an integral structure that is continuous with the spiral tube 44 and the mesh tube 45b of the second bending portion 8. The spiral tubes 44 and 51 and the mesh tubes 45 b and 52 may be provided separately in the second bending portion 8 and the flexible tube portion 9.

そして、本実施の形態では、第２の湾曲部８および可撓管部９の硬さ（曲げ剛性）の違いが湾曲ゴム４７および樹脂管５３の硬さ（曲げ剛性）の違いにより設定されている。そして、上述したように、第２の湾曲部８が非常に柔らかく設定されており、この第２の湾曲部８よりも硬く体腔、特に大腸への挿入に必要な所定の可撓性を有するように可撓管部９の硬さが設定されている。なお、第２の湾曲部８および可撓管部９の硬さは、湾曲ゴム４７および樹脂管５３の硬さの違いに加え、螺旋管４４，５１の螺旋ピッチ、板厚などを変更して設定しても良い。 In the present embodiment, the difference in hardness (bending rigidity) between the second bending portion 8 and the flexible tube portion 9 is set by the difference in hardness (bending rigidity) between the bending rubber 47 and the resin tube 53. Yes. As described above, the second bending portion 8 is set to be very soft, and is harder than the second bending portion 8 so as to have a predetermined flexibility necessary for insertion into a body cavity, particularly the large intestine. The flexibility of the flexible tube portion 9 is set. Note that the hardness of the second bending portion 8 and the flexible tube portion 9 is changed by changing the helical pitch, plate thickness, etc. of the helical tubes 44 and 51 in addition to the difference in hardness between the bending rubber 47 and the resin tube 53. May be set.

さらに、第２の湾曲部８は、図４に示すように、螺旋管４４に変えて第１の湾曲部７と同様に複数の湾曲駒４１を設けて、受動的に湾曲する構成としても良い。なお、ここでは、受動型の第１の湾曲部７および能動型の第２の湾曲部８の境界外周部分の二つの湾曲駒４１がリング状の口金である連結管５５の外周に嵌合されて連結されている。なお、網状管４５ａ，４５ｂは、連結された二つの湾曲駒４１の外周部に半田などでロウ付けされて固着されている。 Further, as shown in FIG. 4, the second bending portion 8 may be configured to be passively bent by providing a plurality of bending pieces 41 similarly to the first bending portion 7 instead of the spiral tube 44. . Here, the two bending pieces 41 at the boundary outer peripheral portion of the passive first bending portion 7 and the active second bending portion 8 are fitted to the outer periphery of the connecting pipe 55 which is a ring-shaped base. Are connected. The mesh tubes 45a and 45b are fixed to the outer peripheral portions of the two connected bending pieces 41 by soldering or the like.

また、ここでは、第１の湾曲部７の外皮を構成する湾曲ゴム４７ａと第２の湾曲部８の外皮を構成する湾曲ゴム４７ｂとが別体となっており、これら湾曲ゴム４７ａ，４７ｂが第１の湾曲部７および第２の湾曲部８の境界外周部分にて糸巻き接着部５６によって接続されている。このように、連結管５５に外嵌して連結された各湾曲駒４１の厚さと、網状管４５ａ，４５ｂが湾曲駒４１に固着された厚みに加え、各湾曲ゴム４７ａ，４７ｂの厚みおよび糸巻き接着部５６の厚さによって、第１の湾曲部７および第２の湾曲部８の境界外周部分に外周回りに突起する、ここでの凸部５０が形成される。 Further, here, the curved rubber 47a constituting the outer skin of the first curved portion 7 and the curved rubber 47b constituting the outer skin of the second curved portion 8 are separated, and these curved rubbers 47a and 47b are separated from each other. The boundary portion between the first bending portion 7 and the second bending portion 8 is connected by a bobbin adhering portion 56. Thus, in addition to the thickness of each bending piece 41 that is externally fitted and connected to the connecting pipe 55 and the thickness in which the mesh tubes 45a and 45b are fixed to the bending piece 41, the thickness of each bending rubber 47a and 47b and the bobbin winding Depending on the thickness of the bonding portion 56, a convex portion 50 is formed that protrudes around the outer periphery of the boundary between the first bending portion 7 and the second bending portion 8.

次に、内視鏡用挿入補助具である内視鏡用オーバーチューブについて、図５に基づいて、以下に説明する。なお、この内視鏡用オーバーチューブは、従来構成と同様であり、本実施の形態における特徴部分以外の説明を省略する。 Next, an endoscope overtube which is an endoscope insertion aid will be described below with reference to FIG. Note that the endoscope overtube has the same configuration as that of the conventional configuration, and the description other than the characteristic portion in the present embodiment will be omitted.

本実施の形態の内視鏡用オーバーチューブ６０は、図５に示すように、先端にゴムなどの弾性部材から形成された円環状のフード６１と、このフード６１が先端部分に接着固定されたシリコンなどから形成された可撓チューブ６２と、この可撓チューブ６２の基端部分が接着固定された略円筒状の把持部６３と、を有して構成されている。この内視鏡用オーバーチューブ６０には、図６に示すように、内視鏡２の挿入部１０が挿入される。 As shown in FIG. 5, an endoscope overtube 60 according to the present embodiment has an annular hood 61 formed of an elastic member such as rubber at the tip, and the hood 61 is bonded and fixed to the tip. A flexible tube 62 made of silicon or the like, and a substantially cylindrical gripping portion 63 to which a proximal end portion of the flexible tube 62 is bonded and fixed are configured. As shown in FIG. 6, the insertion portion 10 of the endoscope 2 is inserted into the endoscope overtube 60.

なお、フード６１は、先細りの円錐状をしており、先端に形成された開口部６４と、開口部６４から後方へ拡がったテーパ部６５と、可撓チューブ６２に外挿して固着される胴部６６と、を有している。このフード６１は、例えば、弾性ゴムから形成し、その硬度が第１の湾曲部７および第２の湾曲部８の外皮を構成する湾曲ゴム４７よりも高く設定されている。 The hood 61 has a tapered conical shape, and has an opening 64 formed at the tip, a taper 65 extending rearward from the opening 64, and a body that is externally fixed to the flexible tube 62. Part 66. The hood 61 is made of, for example, elastic rubber, and the hardness thereof is set higher than that of the curved rubber 47 constituting the outer skin of the first curved portion 7 and the second curved portion 8.

ここで、内視鏡用オーバーチューブ６０の内径および、この内視鏡用オーバーチューブ６０に挿入される内視鏡２の挿入部１０の外径の寸法の関係について、以下に詳しく説明する。 Here, the relationship between the inner diameter of the endoscope overtube 60 and the outer diameter of the insertion portion 10 of the endoscope 2 inserted into the endoscope overtube 60 will be described in detail below.

内視鏡用オーバーチューブ６０は、フード６１の開口部６４の開口径Ｄ１（例えば、Ｄ１＝１０ｍｍ）および、開口径Ｄ１よりも大きな可撓チューブ６２の内径Ｄ２（例えば、Ｄ２＝１３ｍｍ）が設定されている（Ｄ１＜Ｄ２）。 The endoscope overtube 60 has an opening diameter D1 (for example, D1 = 10 mm) of the opening 64 of the hood 61 and an inner diameter D2 (for example, D2 = 13 mm) of the flexible tube 62 larger than the opening diameter D1. (D1 <D2).

挿入部１０は、第１の湾曲部７および第２の湾曲部８の境界外周部分に設けられた凸部５０の外径ｄ１、第２の湾曲部８の外径ｄ２、糸巻き接着部４９の外径ｄ３および可撓管部９の外径ｄ４が設定されている。これら外径ｄ１〜ｄ４の関係は、凸部５０の外径ｄ１（例えば、ｄ１＝１０．５ｍｍ）が最も大きく、糸巻き接着部４９の外径ｄ３（例えば、ｄ３＝９．６ｍｍ）、第２の湾曲部の外径ｄ２および可撓管部９の外径ｄ４が同等、または、可撓管部の外径ｄ４（例えば、ｄ４＝９ｍｍ）が第２の湾曲部の外径ｄ２（例えば、ｄ２＝９．２ｍｍ）よりも小さくなるように設定されている（ｄ１＞ｄ３＞ｄ２≧ｄ４）。なお、第１の湾曲部７は、第２の湾曲部８と同じ外径ｄ２、またはｄ２より小さく設定されている。 The insertion portion 10 includes an outer diameter d1 of the convex portion 50 provided on the boundary outer peripheral portion of the first bending portion 7 and the second bending portion 8, an outer diameter d2 of the second bending portion 8, and the bobbin adhering portion 49. The outer diameter d3 and the outer diameter d4 of the flexible tube portion 9 are set. Regarding the relationship between these outer diameters d1 to d4, the outer diameter d1 (for example, d1 = 10.5 mm) of the convex portion 50 is the largest, the outer diameter d3 (for example, d3 = 9.6 mm) of the bobbin adhering portion 49, the second The outer diameter d2 of the bending portion and the outer diameter d4 of the flexible tube portion 9 are equal, or the outer diameter d4 (for example, d4 = 9 mm) of the flexible tube portion is equal to the outer diameter d2 of the second bending portion (for example, d2 = 9.2 mm) (d1> d3> d2 ≧ d4). The first bending portion 7 is set smaller than the same outer diameter d2 or d2 as the second bending portion 8.

即ち、内視鏡用オーバーチューブ６０の内径Ｄ１，Ｄ２と挿入部１０の外径ｄ１〜ｄ４の関係では、可撓チューブ６２の内径Ｄ２が最も大きく、凸部５０の外径ｄ１、開口部６４の開口径Ｄ１、糸巻き接着部４９の外径ｄ３（なお、糸巻き接着部４９の外径ｄ３は開口部６４の開口径Ｄ１と同じ寸法でも良い）、第２の湾曲部８の外径ｄ２および可撓管部９の外径ｄ４の順で小さくなるように設定されている（Ｄ２＞ｄ１＞Ｄ１≧ｄ３＞ｄ２≧ｄ４）。 That is, in the relationship between the inner diameters D1 and D2 of the endoscope overtube 60 and the outer diameters d1 to d4 of the insertion portion 10, the inner diameter D2 of the flexible tube 62 is the largest, the outer diameter d1 of the convex portion 50, and the opening 64. , The outer diameter d3 of the bobbin adhering portion 49 (the outer diameter d3 of the bobbin adhering portion 49 may be the same as the opening diameter D1 of the opening 64), the outer diameter d2 of the second curved portion 8 and The outer diameter d4 of the flexible tube portion 9 is set so as to decrease in order (D2> d1> D1 ≧ d3> d2 ≧ d4).

このように径方向の寸法が設定された内視鏡用オーバーチューブ６０に挿入部１０を挿入するとき、可撓チューブ６２の内径Ｄ２が最も大きいため、挿入部１０が引っ掛からずに容易に挿入することができる。そして、挿入部１０における最も太径となる凸部５０は、フード６１の先細りのテーパ部６５の内面に当接しながら、開口部６４が弾性変形しながら押し拡げられて、この開口部６４が乗り越えられて、フード６１の先端側に突き出される。 When the insertion portion 10 is inserted into the endoscope overtube 60 having the radial dimension set in this manner, the insertion portion 10 can be easily inserted without being caught because the inner diameter D2 of the flexible tube 62 is the largest. be able to. The convex portion 50 having the largest diameter in the insertion portion 10 is expanded while the opening 64 is elastically deformed while abutting against the inner surface of the tapered taper portion 65 of the hood 61, and the opening 64 gets over. And protruded toward the front end side of the hood 61.

この状態で、挿入部１０および内視鏡用オーバーチューブ６０が内視鏡検査のため患者の体腔に挿入される。なお、挿入部１０は、凸部５０の外径ｄ１がフード６１の開口部６４の開口径Ｄ１よりも大きな寸法（ｄ１＞Ｄ１）であるため、ある程度の力量で手元側に引かれても、凸部５０が開口部６４に引っ掛かり、フード６１内へ入り込むことが防止される。また、内視鏡用オーバーチューブ６０のみが挿入部１０に対して、所定の力量、体腔に挿入する程度の力量で押し込まれたとしても、同様に、フード６１の開口部６４が凸部５０に引っ掛かり、凸部５０を乗り越えることが防止される。なお、挿入部１０を力強く引けば、フード６１の開口部６４が弾性変形により拡がるため、凸部５０の引っ掛かりが解除され、挿入部１０を内視鏡用オーバーチューブ６０から抜き取ることができるようになっている。 In this state, the insertion portion 10 and the endoscope overtube 60 are inserted into the patient's body cavity for endoscopy. In addition, since the outer diameter d1 of the convex part 50 is larger than the opening diameter D1 of the opening part 64 of the hood 61 (d1> D1), the insertion part 10 is pulled to the hand side with a certain amount of force. The convex part 50 is caught in the opening part 64 and is prevented from entering the hood 61. Further, even if only the endoscope overtube 60 is pushed into the insertion portion 10 with a predetermined force amount and a force amount enough to be inserted into the body cavity, the opening portion 64 of the hood 61 is similarly formed on the convex portion 50. It is prevented from getting caught and over the convex part 50. If the insertion portion 10 is pulled strongly, the opening 64 of the hood 61 expands due to elastic deformation, so that the catch of the convex portion 50 is released and the insertion portion 10 can be extracted from the endoscope overtube 60. It has become.

次に、内視鏡用オーバーチューブ６０のフード６１と挿入部１０の第１の湾曲部７および第２の湾曲部８の境界外周部分に設けられた凸部５０の長さの関係について説明する。 Next, the relationship between the length of the convex portion 50 provided on the boundary outer peripheral portion of the hood 61 of the endoscope overtube 60 and the first bending portion 7 and the second bending portion 8 of the insertion portion 10 will be described. .

凸部５０は、挿入部１０の長手軸に沿った長さＬ１（例えば、Ｌ１＝６ｍｍ）を有している。これに対して、フード６１は、孔軸に沿った開口部６４の長さＬ２（例えば、Ｌ２＝２ｍｍ）と、この長さＬ２よりも長いテーパ部６５の長さＬ３（例えば、Ｌ３＝４ｍｍ）が設定されている。 The convex portion 50 has a length L1 (for example, L1 = 6 mm) along the longitudinal axis of the insertion portion 10. On the other hand, the hood 61 has a length L2 (for example, L2 = 2 mm) of the opening 64 along the hole axis, and a length L3 (for example, L3 = 4 mm) of the tapered portion 65 longer than the length L2. ) Is set.

即ち、凸部５０の長さＬ１とフード６１の長さＬ２，Ｌ３の関係は、凸部５０の長さＬ１が最も長く、次いでテーパ部６５の長さＬ３が長く、開口部６４の長さＬ２が最も短くなるように設定されている。 That is, the relationship between the length L1 of the convex portion 50 and the lengths L2 and L3 of the hood 61 is that the length L1 of the convex portion 50 is the longest, then the length L3 of the tapered portion 65 is long, and the length of the opening 64 is L2 is set to be the shortest.

この挿入部１０の凸部５０は、長さＬ１が短いと、挿入部１０がある程度の力量で手元側に引かれたり、内視鏡用オーバーチューブ６０のみが挿入部１０に対して、所定の力量、体腔に挿入する程度の力量で押し込まれたりすると、フード６１が簡単に乗り越えてしまう。また、フード６１の開口部６４は、長さＬ２が長いと、外側に弾性変形し易くなり、挿入部１０の凸部５０に当接して確実に止める効果が低下する。さらに、テーパ部６５は、長さＬ３が長いと、フード６１に挿入部１０の凸部５０が突き当たった後、内側に捲れ易くなる。これらを防止できるように、凸部５０の長さＬ１、開口部６４の長さＬ２およびテーパ部６５の長さＬ３の最適な関係と長さが設定されている。 When the length L1 of the convex portion 50 of the insertion portion 10 is short, the insertion portion 10 is pulled toward the hand side with a certain amount of force, or only the endoscope overtube 60 is fixed to the insertion portion 10 with a predetermined length. The hood 61 can easily get over when it is pushed in with a force and a force sufficient to be inserted into the body cavity. In addition, when the length L2 of the opening 64 of the hood 61 is long, the opening 64 is easily elastically deformed to the outside, and the effect of reliably abutting against the convex portion 50 of the insertion portion 10 is reduced. Furthermore, if the length L3 is long, the taper portion 65 is likely to bend inward after the convex portion 50 of the insertion portion 10 abuts against the hood 61. In order to prevent these, the optimum relationship and length of the length L1 of the convex portion 50, the length L2 of the opening portion 64, and the length L3 of the tapered portion 65 are set.

ここで、以上のように構成された内視鏡２の挿入部１０を患者の体腔である大腸に挿入する挿入操作について説明する。
先ず、内視鏡２は、第１の湾曲部７および第２の湾曲部８の境界外周部分に設けられた凸部５０がフード６１の開口部６４から導出した状態となるように、内視鏡用オーバーチューブ６０の把持部６３側から挿入部１０が挿入される。つまり、挿入部１０の第１の湾曲部７が内視鏡用オーバーチューブ６０から突き出した状態となる。 Here, an insertion operation for inserting the insertion portion 10 of the endoscope 2 configured as described above into the large intestine which is a body cavity of the patient will be described.
First, the endoscope 2 is arranged so that the convex portion 50 provided on the boundary outer peripheral portion of the first bending portion 7 and the second bending portion 8 is in a state derived from the opening 64 of the hood 61. The insertion part 10 is inserted from the grip part 63 side of the mirror overtube 60. That is, the first bending portion 7 of the insertion portion 10 protrudes from the endoscope overtube 60.

内視鏡用オーバーチューブ６０に挿入された挿入部１０は、図７に示すように、肛門１０１から挿入されて、湾曲部７の湾曲操作と共に押し込まれることで、曲がりくねったＳ状結腸１０２および下行結腸１０３を介して脾湾曲部１０４まで到達する。なお、挿入部１０は、押し込み操作のみで、柔軟な第２の湾曲部８が受動的に屈曲形状に沿って湾曲して、腸壁を突き上げることなく、スムーズに脾湾曲部１０４まで到達する。そして、挿入部１０は、図８に示すように、脾湾曲部１０４の屈曲形状に合わせて第１の湾曲部７が湾曲操作され、横行結腸１０５側に先端部６が方向付けられる。 The insertion portion 10 inserted into the endoscope overtube 60 is inserted from the anus 101 and pushed together with the bending operation of the bending portion 7 as shown in FIG. The spleen curved portion 104 is reached through the colon 103. In addition, the insertion part 10 can reach the spleen bending part 104 smoothly without pushing up the intestinal wall by bending the flexible second bending part 8 passively along the bending shape only by pushing operation. Then, as shown in FIG. 8, in the insertion portion 10, the first bending portion 7 is bent in accordance with the bent shape of the spleen bending portion 104, and the distal end portion 6 is directed to the transverse colon 105 side.

その後、内視鏡用オーバーチューブ６０は、図９に示すように、挿入部１０に沿って押し込まれる。このとき、内視鏡用オーバーチューブ６０は、図１０に示すように、フード６１が凸部５０に突き当たるまで挿入部１０に沿って押し込まれる。なお、内視鏡用オーバーチューブ６０は、フード６１の開口部６４が凸部５０を乗り越えることなく突き当たり、挿入部１０を被覆する位置、即ち、第２の湾曲部８および可撓管部９のみを覆う位置が規定される。そのため、挿入部１０は、第１の湾曲部７が内視鏡用オーバーチューブ６０のフード６１から導出した状態となる。 Thereafter, the endoscope overtube 60 is pushed in along the insertion portion 10, as shown in FIG. At this time, as shown in FIG. 10, the endoscope overtube 60 is pushed along the insertion portion 10 until the hood 61 hits the convex portion 50. Note that the endoscope overtube 60 abuts the opening 64 of the hood 61 without getting over the convex portion 50 and covers the insertion portion 10, that is, only the second bending portion 8 and the flexible tube portion 9. A position to cover is defined. Therefore, the insertion portion 10 is in a state where the first bending portion 7 is led out from the hood 61 of the endoscope overtube 60.

ところで、挿入部１０では、図１１に示すように、例えば、脾湾曲部１０４の屈曲部に先端（先端部６）を引掛けた状態で捻り操作および牽引操作して腸を直線化しようとすると、第２の湾曲部８が柔軟なためコシ砕けてしまい、先端が脾湾曲部１０４の屈曲部に上手く引っ掛からず、抜けてしまう場合がある。これにより、第２の湾曲部８を備えた挿入部１０は、腸を直線化し難い場合がある。しかし、内視鏡用オーバーチューブ６０によって第２の湾曲部８を覆うことで、第２の湾曲部８によるコシ砕けが防止される。 By the way, in the insertion part 10, as shown in FIG. 11, for example, when the distal end (tip part 6) is hooked on the bent part of the spleen curved part 104, the twisting operation and the pulling operation are performed to straighten the intestine. The second bending portion 8 may be crushed because it is flexible, and the tip may not be easily caught by the bent portion of the spleen bending portion 104 and may come off. Thereby, the insertion part 10 provided with the 2nd bending part 8 may be difficult to linearize an intestine. However, by covering the second bending portion 8 with the endoscope overtube 60, the crunchiness caused by the second bending portion 8 is prevented.

次に、挿入部１０および内視鏡用オーバーチューブ６０が捻り操作および牽引操作されて、図１２に示すように、肛門１０１からＳ状結腸１０２および下行結腸１０３が短縮化されて直線化する状態とされる。このとき、内視鏡用オーバーチューブ６０により第２の湾曲部８によるコシ砕けが防止されるため、Ｓ状結腸１０２および下行結腸１０３の直線化が容易に行われる。 Next, the insertion portion 10 and the endoscope overtube 60 are twisted and pulled, and the sigmoid colon 102 and descending colon 103 are shortened and straightened from the anus 101 as shown in FIG. It is said. At this time, the sigmoid colon 102 and the descending colon 103 can be easily linearized because the endoscope overtube 60 prevents the crunchiness caused by the second bending portion 8.

そして、図１３に示すように、挿入部１０のみが内視鏡用オーバーチューブ６０にスライドするように横行結腸１０５内に押し込まれ、挿入部１０の先端が肝湾曲部１０６まで到達する。次に、図１４に示すように、フード６１が凸部５０に突き当たるまで、内視鏡用オーバーチューブ６０が挿入部１０に沿って押し込まれる。ここでも、内視鏡用オーバーチューブ６０は、フード６１の開口部６４が凸部５０を乗り越えることなく突き当たり、挿入部１０を被覆する位置、即ち、第２の湾曲部８および可撓管部９のみを覆う位置が規定される。そのため、挿入部１０は、第１の湾曲部７が内視鏡用オーバーチューブ６０のフード６１から導出した状態となる。 Then, as shown in FIG. 13, only the insertion portion 10 is pushed into the transverse colon 105 so as to slide into the endoscope overtube 60, and the distal end of the insertion portion 10 reaches the liver bending portion 106. Next, as shown in FIG. 14, the endoscope overtube 60 is pushed in along the insertion portion 10 until the hood 61 hits the convex portion 50. Also in this case, the endoscope overtube 60 abuts the opening 64 of the hood 61 without getting over the convex portion 50 and covers the insertion portion 10, that is, the second bending portion 8 and the flexible tube portion 9. A position that covers only the surface is defined. Therefore, the insertion portion 10 is in a state where the first bending portion 7 is led out from the hood 61 of the endoscope overtube 60.

挿入部１０は、肝湾曲部１０６の屈曲形状に合わせて第１の湾曲部７が湾曲操作されて、横行結腸１０５側に先端部６が方向付けられる。そして、挿入部１０および内視鏡用オーバーチューブ６０が捻り操作および牽引操作され、図１５に示すように、横行結腸１０５が短縮化して直線化される。挿入部１０のみが内視鏡用オーバーチューブ６０にスライドされ、上行結腸１０７に押し込まれ、挿入部１０が大腸深部まで挿入される。 In the insertion portion 10, the first bending portion 7 is bent in accordance with the bent shape of the liver bending portion 106, and the distal end portion 6 is directed to the transverse colon 105 side. Then, the insertion section 10 and the endoscope overtube 60 are twisted and pulled, and the transverse colon 105 is shortened and straightened as shown in FIG. Only the insertion part 10 is slid to the endoscope overtube 60 and pushed into the ascending colon 107, and the insertion part 10 is inserted to the deep part of the large intestine.

このように本実施の形態の内視鏡システム１は、内視鏡２の挿入部１０の第１の湾曲部７および第２の湾曲部８の境界外周部分に外周回りに突起する凸部５０を形成して、内視鏡用オーバーチューブ６０を挿入部１０の先端側へ押し込むときに、凸部５０に内視鏡用オーバーチューブ６０の先端に設けられたフード６１が突き当たり停止するようになっている。これにより、内視鏡用オーバーチューブ６０は、挿入部１０の先端側へ押し込むときに、挿入部１０の第１の湾曲部７を覆うことがない位置を規制することができる。 As described above, the endoscope system 1 according to the present embodiment has the convex portion 50 protruding around the outer periphery of the boundary between the first bending portion 7 and the second bending portion 8 of the insertion portion 10 of the endoscope 2. When the endoscope overtube 60 is pushed into the distal end side of the insertion portion 10, the hood 61 provided at the distal end of the endoscope overtube 60 comes into contact with the convex portion 50 and stops. ing. Thereby, when the endoscope overtube 60 is pushed into the distal end side of the insertion portion 10, a position where the first bending portion 7 of the insertion portion 10 is not covered can be regulated.

以上の説明から、内視鏡システム１は、患者の体腔内へ挿入される内視鏡２の挿入部１０に設けられた能動的に湾曲される第１の湾曲部７を内視鏡用オーバーチューブ６０が覆った状態で湾曲操作されることがないため、第１の湾曲部７の湾曲を規制することなく、第１の湾曲部７に無理な負荷が与えられることが無いため、破損などが防止される。さらに、内視鏡システム１は、挿入部１０の受動的に湾曲する第２の湾曲部８が内視鏡用オーバーチューブ６０に覆われることでコシ砕けが防止されるため、体腔の屈曲部に引っ掛けた挿入部１０の先端が抜け難く、体腔を短縮化して直線化する挿入操作を容易に行える。したがって、内視鏡用オーバーチューブ６０と内視鏡２を備えた内視鏡システム１は、能動的に湾曲される第１の湾曲部７および受動的に湾曲する第２の湾曲部８を備えた挿入部１０の体腔への挿入性が向上する。 From the above description, the endoscope system 1 has the first bending portion 7 that is actively bent provided in the insertion portion 10 of the endoscope 2 inserted into the body cavity of the patient over the endoscope. Since the bending operation is not performed in a state where the tube 60 is covered, the first bending portion 7 is not restricted from being bent and an excessive load is not applied to the first bending portion 7, so that the first bending portion 7 is not damaged. Is prevented. Furthermore, the endoscope system 1 prevents the crushing by preventing the second bending portion 8 of the insertion portion 10 that is passively bent from being covered with the endoscope overtube 60, so that the bending portion of the body cavity The tip of the hooked insertion portion 10 is difficult to come out, and an insertion operation for shortening and straightening the body cavity can be easily performed. Therefore, the endoscope system 1 including the endoscope overtube 60 and the endoscope 2 includes the first bending portion 7 that is actively bent and the second bending portion 8 that is passively bent. The insertion property of the inserted portion 10 into the body cavity is improved.

さらに、フード６１の硬度が第１の湾曲部７および第２の湾曲部８の外皮を構成する湾曲ゴム４７よりも高く設定されているため、内視鏡用オーバーチューブ６０が挿入部１０に沿って押し込まれてフード６１が凸部５０に突き当たるときに、このフード６１が内側に捲れたりして挿入部１０を破損することなく、確実に内視鏡用オーバーチューブ６０が挿入部１０の所定の位置で止まるようになっている。 Furthermore, since the hardness of the hood 61 is set higher than that of the curved rubber 47 constituting the outer skin of the first curved portion 7 and the second curved portion 8, the endoscope overtube 60 extends along the insertion portion 10. When the hood 61 hits the convex portion 50 by being pushed in, the hood 61 does not sag inward and the insertion portion 10 is not damaged, so that the endoscope overtube 60 is securely inserted into the predetermined portion of the insertion portion 10. It stops at the position.

（第１の変形例）
内視鏡用オーバーチューブ６０のフード６１は、図１７に示すように、開口部６４の開口径Ｄ１よりも小さな内径Ｄ３（Ｄ１＞Ｄ３）となるように、開口部６４とテーパ部６５の境界部分に内径方向に突起する突起部６７を設けても良い。なお、この突起部６７は、フード６１の内周面の周方向に突起形成されているものである。 (First modification)
As shown in FIG. 17, the hood 61 of the endoscope overtube 60 has a boundary between the opening portion 64 and the taper portion 65 so that the inner diameter D3 (D1> D3) is smaller than the opening diameter D1 of the opening portion 64. You may provide the protrusion part 67 which protrudes in an internal diameter direction in a part. The protrusion 67 is formed so as to protrude in the circumferential direction of the inner peripheral surface of the hood 61.

なお、突起部６７により形成される孔部の内径Ｄ３（例えば、９．４ｍｍ）は、挿入部１０の第２の湾曲部８（および第１の湾曲部７）の外径ｄ２（例えば、９．２ｍｍ）以上（Ｄ３≧ｄ２）であって、糸巻き接着部４９の外径ｄ３（例えば、９．６ｍｍ）よりも小さく（Ｄ３＜ｄ３）設定されている。 The inner diameter D3 (for example, 9.4 mm) of the hole formed by the protrusion 67 is the outer diameter d2 (for example, 9) of the second bending portion 8 (and the first bending portion 7) of the insertion portion 10. .2 mm) or more (D3 ≧ d2), which is smaller than the outer diameter d3 (for example, 9.6 mm) of the bobbin adhering portion 49 (D3 <d3).

以上のような構成とすることで、内視鏡用オーバーチューブ６０のフード６１は、突起部６７が挿入部１０の第２の湾曲部８および可撓管部９とのクリアランスが狭まることで、その隙間から内視鏡用オーバーチューブ６０内への汚物の流入、および腸の粘膜の巻き込みを防止することができる。 With the configuration as described above, the hood 61 of the endoscope overtube 60 has a narrowed clearance between the protrusion 67 and the second bending portion 8 and the flexible tube portion 9 of the insertion portion 10. It is possible to prevent the inflow of filth into the endoscope overtube 60 and the entrapment of the intestinal mucosa from the gap.

なお、ここでも、フード６１は、孔軸に沿った開口部６４の長さＬ２（例えば、Ｌ２＝２ｍｍ）と、この長さＬ２よりも長い孔軸に沿ったテーパ部６５の長さＬ３（例えば、Ｌ３＝４ｍｍ）が設定されている。即ち、ここでも凸部５０の長さＬ１とフード６１の長さＬ２，Ｌ３の関係は、凸部５０の長さＬ１が最も長く、次いでテーパ部６５の長さＬ３が長く、開口部６４の長さＬ２が最も短くなるように設定されているものである。 Also in this case, the hood 61 has a length L2 (for example, L2 = 2 mm) of the opening 64 along the hole axis, and a length L3 of the tapered portion 65 along the hole axis longer than the length L2 ( For example, L3 = 4 mm) is set. In other words, the relationship between the length L1 of the convex portion 50 and the lengths L2 and L3 of the hood 61 is the longest length L1 of the convex portion 50, and then the length L3 of the tapered portion 65 is long. The length L2 is set to be the shortest.

（第２の変形例）
なお、内視鏡用オーバーチューブ６０は、図１８に示すように、可撓チューブ６２の先端部分にシリコンなどからなるバルーン７１を設けることで、腸を短縮化して直線化する挿入操作が行い易い構成となる。なお、可撓チューブ６２は、図１９に示すように、バルーン７１へ気体を送気するための管路６２ａが肉厚部に形成されたマルチルーメンチューブである。また、可撓チューブ６２は、バルーン７１内に管路６２ａに送気された気体を放出して、バルーン７１を膨らますために、管路６２ａに連通する孔部６２ｂが複数形成されている。さらに、把持部６３には、可撓チューブ６２の管路６２ａに連通する送気口金７２が配設されている構成となっている。 (Second modification)
As shown in FIG. 18, the endoscope overtube 60 is provided with a balloon 71 made of silicon or the like at the distal end portion of the flexible tube 62, so that an insertion operation for shortening and straightening the intestine can be easily performed. It becomes composition. As shown in FIG. 19, the flexible tube 62 is a multi-lumen tube in which a pipe line 62a for feeding gas to the balloon 71 is formed in a thick portion. The flexible tube 62 has a plurality of holes 62b communicating with the conduit 62a in order to release the gas sent to the conduit 62a into the balloon 71 and inflate the balloon 71. Further, the gripping portion 63 has a configuration in which an air supply base 72 that communicates with the conduit 62 a of the flexible tube 62 is disposed.

以上の実施の形態に記載した発明は、その実施の形態および変形例に限ることなく、その他、実施段階ではその要旨を逸脱しない範囲で種々の変形を実施し得ることが可能である。さらに、上記実施の形態には、種々の段階の発明が含まれており、開示される複数の構成要件における適宜な組み合わせにより種々の発明が抽出され得るものである。 The invention described in the above embodiment is not limited to the embodiment and modifications, and various modifications can be made without departing from the scope of the invention in the implementation stage. Further, the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

例えば、実施の形態に示される全構成要件から幾つかの構成要件が削除されても、述べられている課題が解決でき、述べられている効果が得られる場合には、この構成要件が削除された構成が発明として抽出される得るものである。 For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the described requirements can be deleted if the stated problem can be solved and the stated effect can be obtained. Such a configuration can be extracted as an invention.

１…内視鏡システム
２…内視鏡
６…先端部
７…第１の湾曲部
８…第２の湾曲部
９…可撓管部
１０…挿入部
４１…湾曲駒
４２…湾曲ワイヤ
４３…コイルシース
４４，５１…螺旋管
４５ａ，４５ｂ，５２…網状管
４７，４７ａ，４７ｂ…湾曲ゴム
４８，４９…糸巻き接着部
５０…凸部
５３…樹脂管
５４…連結管
５４ａ…ロウ付部
５５…連結管
５６…接着部
６０…内視鏡用オーバーチューブ
６１…フード
６２…可撓チューブ
６３…把持部
６４…開口部
６５…テーパ部
６６…胴部
６７…突起部 DESCRIPTION OF SYMBOLS 1 ... Endoscope system 2 ... Endoscope 6 ... Tip part 7 ... 1st bending part 8 ... 2nd bending part 9 ... Flexible tube part 10 ... Insertion part 41 ... Bending piece 42 ... Bending wire 43 ... Coil sheath 44, 51 ... spiral pipes 45a, 45b, 52 ... mesh pipes 47, 47a, 47b ... curved rubber 48, 49 ... thread wound adhesive part 50 ... convex part 53 ... resin pipe 54 ... connecting pipe 54a ... brazed part 55 ... connecting pipe 56 ... Adhesive part 60 ... End tube 61 for endoscope ... Hood 62 ... Flexible tube 63 ... Gripping part 64 ... Opening part 65 ... Taper part 66 ... Trunk part 67 ... Projection part

Claims

An insertion part to be inserted into the body cavity;
A first bending portion that is provided in the insertion portion and is actively bent by a bending operation;
A second bending portion connected to the first bending portion and passively bending by an external force;
A convex portion provided at a boundary portion between the first curved portion and the second curved portion, and having a protrusion formed around an outer periphery;
An endoscope with
A flexible tube through which the insertion portion can be inserted;
An annular hood formed at the tip of the flexible tube and formed from an elastic member having an opening diameter smaller than the outer diameter of the convex portion;
An insertion aid for an endoscope comprising:
An endoscope system comprising:

The hood is provided on the distal end side, and is formed with an opening having a predetermined length along the hole axis and tapered toward the opening, and the length along the hole axis is the length of the opening. A taper portion set longer than the predetermined length,
2. The endoscope according to claim 1, wherein the length of each of the opening and the tapered portion is set to be shorter than the length of the convex portion along the longitudinal axis of the insertion portion. system.

The endoscope system according to claim 2, wherein the hood has a protrusion formed in the circumferential direction of the inner peripheral surface of the opening.

The endoscope system according to claim 3, wherein an inner diameter of the hole formed by the protrusion is equal to or larger than an outer diameter of the second curved portion.