JP2014014557A - Endoscope apparatus and endoscope system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an extra fine endoscope and an endoscope system, capable of easily changing the course to a desired direction.SOLUTION: An insertion part 7 of an endoscope has a tip hard part 19 and a flexible tube 20. An observation optical system 22 and an image guide 24 are stored in the tip hard part 19. The flexible tube 20 is provided with sliding projection parts 40a, 40b, and fixed to the tip hard part 19 in the state of being liable to bend. A guide sheath 4 in which the insertion part 7 is stored is provided with cam grooves 52a, 52b formed on the inner peripheral surface. The insertion part 7 is rotated around an axis by sliding between the sliding projection parts 40a, 40b and the cam grooves 52a, 52b to change the bending direction of the insertion part 7.

Description

  The present invention relates to an ultrafine endoscope apparatus and an endoscope system having a limited outer diameter.

  In recent years, diagnosis using a three-dimensional image has been widely performed. For example, a tomographic image of a patient is picked up by an X-ray CT (Computed Tomography) apparatus or the like, and three-dimensional image data inside the body is obtained, and a target region is diagnosed using the three-dimensional image data.

  In the CT apparatus, while continuously feeding the patient in the body axis direction, X-ray irradiation and detection of X-rays that have passed through the body and partly absorbed and attenuated in the body, A three-dimensional region in the body is continuously scanned in a helical manner (helical scan). Then, a three-dimensional image is created from a large number of continuous two-dimensional tomographic images.

  One of the three-dimensional images used for diagnosis is a three-dimensional image of lung bronchi. The three-dimensional image of the bronchus is used to three-dimensionally grasp the position of an abnormal part suspected of lung cancer, for example. In order to confirm the abnormal part by biopsy, for example, a catheter is inserted to collect a tissue sample. In this case, under X-ray fluoroscopy, a catheter having an X-ray opaque metal marker is inserted at the tip, and the diseased part is reached in a half-explored state. However, it is difficult to reach the right place with a fluoroscopic black and white two-dimensional image. In some cases, the tissue of a different place must be collected and the catheter must be inserted again. The burden on the surgeon is also great.

  Further, in a duct in the body having a multi-stage branch such as a bronchi, when the location of the abnormal part is close to the end of the bronchus, it is difficult to correctly reach the target site in a short time in the endoscope. For this purpose, for example, as disclosed in Patent Document 1, a three-dimensional image of a pipeline is created based on image data of a three-dimensional region inside the body, and the target point is reached along the pipeline on the three-dimensional image. Insertion support apparatus that obtains the path of the image, creates a virtual endoscopic image of the duct along the path based on the image data, and displays the virtual endoscopic image, thereby navigating the bronchoscope to the target site Has been proposed.

  In Patent Document 2, a tip end portion of an optical fiber sensor composed of an optical fiber and a flexible coating covering the optical fiber is bent in advance with a desired bending radius, and the bent optical fiber sensor is formed into a straight shape. A configuration has been proposed in which the bending angle of the optical fiber sensor coming out of the straight tube can be arbitrarily set by inserting the tube into the tube and moving the optical fiber sensor back and forth in the straight tube. Such a configuration eliminates the need for a joint ring connection structure as compared to an endoscope having a tip portion structure in which a plurality of joint rings are swingably connected by pin coupling and the tip portion is bent by wire operation. The diameter can be reduced.

JP 2009-279251 A JP-A 61-273517

  However, using an endoscope using an extremely thin optical fiber sensor as disclosed in Patent Document 2 and an insertion support device for an endoscope disclosed in Patent Document 1, navigation for insertion is performed. There is a problem in that a desired bending angle or rotation angle cannot be obtained even if the route is changed toward the target pipeline at the branching portion. In particular, in an ultra-thin endoscope with a limited diameter, the torque is not transmitted to the distal end of the insertion section, even if the insertion section is rotated on the proximal side to rotate the distal end of the insertion section, and the direction of the distal end is considered. Can not be rotated. For this reason, there is a problem that it is impossible to quickly reach the target portion of the endoscope because it is necessary to change the course by retracting the endoscope after it has been retracted and returning it.

  The present invention has been made in view of the above problems, and an object of the present invention is to provide an ultra-fine endoscope apparatus and an endoscope system that can easily change the course in a desired direction with a simple configuration. .

  In order to achieve the above object, in the present invention, a distal end rigid portion disposed at the distal end, an observation unit attached to the distal end rigid portion, a flexible tube connected to the proximal end side of the distal end rigid portion and provided with a curl, And an endoscope provided with an insertion portion having a first sliding engagement portion provided on an outer peripheral surface of the flexible tube, an operation portion attached to a proximal end of the insertion portion, and the insertion portion accommodated And a guide sheath having a second sliding engagement portion formed on the inner peripheral surface so as to slide with the first sliding engagement portion and obliquely with respect to the axial direction of the insertion portion. Features. Thereby, it is not necessary to provide a plurality of joint rings and the like, the configuration is simplified, and it is possible to contribute to the miniaturization of the endoscope.

  The first sliding engagement portion is preferably a sliding projection protruding from the outer peripheral surface of the flexible tube, and the second sliding engagement portion is preferably a cam groove that slides with the projection. Further, the guide sheath preferably includes a guide groove having a tapered surface that is continuous with the base end of the cam groove and gradually decreases in width toward the cam groove. Thereby, the sliding projection is smoothly engaged with the cam groove. Further, the length of the second sliding engagement portion in the axial direction is longer than the portion of the flexible tube to which the bending hook is applied, and the first sliding and the portion where the bending hook starts toward the tip side. It is preferable that it is shorter than the distance with an engaging part.

  The flexible tube includes a pair of first sliding engagement portions, and the guide sheath has a pair of second sliding engagement portions matched with the first sliding engagement portions. Thereby, an insertion part can be stably rotated with respect to a guide sheath.

  The flexible tube has a distal end surface formed obliquely with respect to a plane orthogonal to the cylindrical core, and the distal end rigid portion is based on an edge located on the distal end side of the distal end surface of the flexible tube. It is preferable to include a fixing portion that fixes the flexible tube in a state where the end edge located on the end side is pulled to the same position in the cylinder core direction. The flexible tube has a fixing attachment hole formed at a predetermined distance from an edge located on the distal end side and at a predetermined distance from an edge located on the proximal end side of the flexible tube. The fixing portion is preferably a fitting protrusion that protrudes from the outer peripheral surface of the distal end hard portion, is disposed at the same position in the cylindrical core direction of the distal end hard portion, and fits with each of the attachment holes. Thereby, the bending part which provided the bending wrinkle to the flexible tube can be formed reliably.

  It is preferable that the guide sheath has a retaining portion that locks the sliding projection on the distal end side of the cam groove, and the retaining portion restricts the insertion portion from being detached toward the distal end side of the guide sheath.

  The observation unit preferably includes a distal end rigid portion, an observation optical system and an image guide attached to the distal end rigid portion, and an outer diameter of the flexible tube excluding the sliding protrusion is 2.0 mm or less. By using the observation optical system and the image guide, it is possible to contribute to the miniaturization of the endoscope as compared with the one using an imaging unit that is currently limited in size. In addition, by setting the outer diameter of the flexible tube to 2.0 mm or less, the entire outer diameter including the guide sheath can be 2.4 mm or less, and the insertion part can be used as a bronchoscope to a portion close to extinction. The tip can be reached.

  The distal end hard part incorporates a sealing part that seals in a state where the observation optical system and the image guide are kept airtight, and the fixing part is located outside the sealing part in the radial direction of the distal end hard part. It is preferable to do.

  The guide sheath includes a straight tubular outer tube and an inner tube disposed on the inner peripheral surface distal end side of the outer tube and formed with a cam groove, and the inner tube is a metal formed of a metal that is opaque to X-rays. A marker is preferred. Thereby, the guide sheath and the distal end of the insertion part can reach the target site while detecting the position of the metal marker under fluoroscopy. Moreover, it is preferable to provide a treatment instrument that is inserted through the guide sheath and can be moved in and out from the distal end of the guide sheath.

  An endoscope system according to the present invention includes an endoscope device, virtual image generation means for generating a virtual endoscopic image of the observation target lumen based on three-dimensional image data of the observation target, and the observation target It is preferable to include an insertion support apparatus having image display means for displaying a plurality of virtual endoscopic images at a branching portion where the lumen branches.

  According to the present invention, the bending tube is given to the flexible tube, and the second sliding engagement portion provided on the outer peripheral surface of the flexible tube is formed on the inner peripheral surface of the guide sheath. Since it slides with the engaging portion, the insertion portion can be bent, and the distal end portion of the insertion portion can be easily changed to a desired direction. Moreover, in the state accommodated in the guide sheath, the insertion portion is accommodated in a straight tube state by the guide sheath. By changing the state between the bent state and the straight tube state, and rotating by the sliding protrusion and the cam groove, the distal end of the insertion portion can be advanced in an arbitrary direction. And the structure which connects a some joint ring becomes unnecessary, and the outer diameter of an insertion part can be made small.

It is the schematic which shows an endoscope system. It is explanatory drawing which shows the usage condition of an endoscope system. It is explanatory drawing which shows another usage pattern of an endoscope system. It is a disassembled perspective view which shows the structure of an insertion part. It is principal part sectional drawing of an insertion part and a guide sheath. It is the perspective view which looked at the front-end | tip rigid part from the base end side. It is a perspective view which shows the structure of a flexible tube. It is explanatory drawing which shows the process of assembling a flexible tube to a front-end | tip hard part. It is a perspective view which shows the structure of the insertion pipe | tube of a guide sheath. It is an expanded view of the inner tube | pipe in which the cam groove was formed. It is principal part sectional drawing of the insertion part used as the bending state. FIG. 12 is a cross-sectional view of a main part of the insertion portion in a state in which it is in a direction different from that of FIG. 11 after being bent. It is explanatory drawing which shows the insertion path | route setting screen of an insertion assistance apparatus. It is explanatory drawing which shows the insertion assistance screen of an insertion assistance apparatus. It is explanatory drawing which shows an example of the change of the observation image of an endoscope, The state (B) before bending an insertion part, and the state (B) which adjusted the position of the observation image by bending and rotating an insertion part It is description which shows.

  As shown in FIG. 1, the endoscope system 2 of the present invention includes an endoscope main body 3, an endoscope apparatus 5 having a guide sheath 4, and an insertion support apparatus 6. The endoscope main body 3 has an insertion portion 7 and a hand operation portion 8. As shown in FIG. 2, the endoscope body 3 is inserted into the bronchus 10 which is a lumen in the body of a patient 9, for example, so that the inside of the bronchus 10 can be observed. In addition, the endoscope apparatus 5 includes a treatment instrument 11, and after inserting the insertion portion 7 and the guide sheath 4 to the vicinity of the target site 10 </ b> A in the bronchus 10, the insertion portion 7 is pulled out from the guide sheath 4. The treatment instrument 11 is inserted into the guide sheath 4. The treatment instrument 11 is, for example, a biopsy forceps having a cup 11 </ b> A capable of collecting a biological tissue at the distal end portion. The treatment instrument 11 is inserted into the guide sheath 4 and can be protruded and retracted from the distal end of the guide sheath 4.

  As shown in FIG. 3, the endoscope system 2 may be used in combination with an endoscope apparatus 12 other than the endoscope apparatus 5. The endoscope device 12 is connected to the distal end portion 13A containing an imaging means such as a CCD, the insertion portion 13 provided with a bending portion 13B having a structure in which a joint ring is connected, and the proximal end of the insertion portion 13. This is a conventional endoscope that includes a hand operation unit 14, an insertion unit 13, and a treatment instrument insertion channel (not shown) provided inside the hand operation unit 14. 14A, and the distal end portion 13A has a treatment instrument outlet 13C. The insertion portion 13 of the endoscope apparatus 12 cannot be inserted into the thin duct of the bronchus 10 and may not reach the target site 10A close to the end of the bronchus 10. In this case, the endoscope apparatus 5 of the present invention is inserted from the treatment instrument inlet 14A into the treatment instrument insertion channel of the endoscope apparatus 12, and the guide sheath 4 and the insertion portion 7 are projected from the treatment instrument outlet 13C. The guide sheath 4 and the insertion portion 7 have an outer diameter smaller than that of the insertion portion 13 of the endoscope apparatus 12 and can be inserted up to a conduit that is thinner than the insertion portion 13.

  As shown in FIGS. 4 and 5, the insertion portion 7 is divided into a distal end rigid portion 19 and a flexible tube 20. The distal end rigid portion 19 located at the distal end of the insertion portion 7 is formed from a rigid synthetic resin or metal cylindrical body, and the distal end outer peripheral surface is tapered. An observation optical system 22, a light guide 23, and an image guide 24 are accommodated in the distal end rigid portion 19. For this reason, the inner peripheral surface of the distal end rigid portion 19 is formed with a first inner peripheral surface 19a, a second inner peripheral surface 19b, and a third inner peripheral surface 19c having different inner diameters in order from the distal end.

  The observation optical system 22 includes a first lens 25, a diaphragm 26, a second lens 27, and a third lens 28 arranged in order from the tip. Among these, the diaphragm 26, the second lens 27, and the third lens 28 are housed in the lens barrel 29.

  The first inner peripheral surface 19a of the distal end rigid portion 19 functions as a first lens holding portion and is formed up to the vicinity of the outer peripheral surface. The first lens 25 of the observation optical system 22 is fixed to the first inner peripheral surface 19a. The second inner peripheral surface 19b has an inner diameter that is smaller than the inner diameter of the first inner peripheral surface 19a, and functions as a locking step for preventing the lens barrel 29 from falling off. The third inner peripheral surface 19c has an inner diameter that is smaller than the inner diameter of the first inner peripheral surface 19a and larger than the inner diameter of the second inner peripheral surface 19b.

  As shown in FIGS. 4 and 6, the second inner peripheral surface 19 b and the third inner peripheral surface 19 c are partially cut out, and the cut portions function as the light guide introduction groove 30. Four light guide introduction grooves 30 are formed at a 90 ° pitch in the circumferential direction. The light guide 23 is inserted into the light guide introduction groove 30. The light guide 23 is composed of an optical fiber bundle in which optical fibers are bundled, and the distal end portion 23a is divided into four and inserted into each light guide introduction groove 30. A light source 31 (see FIG. 1) is provided at the base end of the light guide 23. Illumination light from the light source 31 is emitted from the tip of the light guide 23 and illuminates the patient's body. As the light source 31, for example, a light source provided in an external light source device connected to the endoscope main body 3 via a connector is preferable, or a light source built in the endoscope main body 3 may be used.

  On the third inner peripheral surface 19 c of the distal end rigid portion 19, a lens barrel holding portion 32 is formed to protrude inward between the light guide introduction grooves 30. The lens barrel holding portion 32 holds the lens barrel 29 of the observation optical system 22. Reference numeral 33 denotes a front end cover of the image guide 24, reference numeral 34 denotes a protective tube for the image guide 24, and reference numeral 35 denotes a protective tube for the light guide 23. In FIG. 4, the protection tube 34 and the protection tube 35 are not shown in order to prevent the drawing from being complicated.

  The tip cover 33 is formed of, for example, a hard synthetic resin or metal cylinder, is fixed to the tip of the image guide 24, and is inserted into the lens barrel 29. The image guide 24 inserted into the lens barrel 29 together with the tip cover 33 is fixed at a position where the center axis is on the same axis as the optical axis of the observation optical system 22 and the tip surface is close to the third lens 28. ing. Thereby, the tip rigid part 19, the observation optical system 22, and the image guide 24 are integrated as an observation unit. The protective tube 34 is inserted into the lens barrel 29 located inside the lens barrel holding portion 32 to a position close to the base end portion, which covers the image guide 24.

  The outer peripheral surface of the distal end rigid portion 19 is divided from the distal end into a tapered surface 19d, an outer peripheral surface 19e, and a flexible tube attachment step portion 19f. Further, the lens barrel holding portion 32 protrudes from the rear end of the distal end rigid portion 19 in the tube core direction. A protective tube 35 of the light guide 23 is fixed to the lens barrel holding portion 32 extending from the rear end. Further, the distal end side tube 37 of the flexible tube 20 is covered from above the protective tube 35. The outer peripheral surface of the flexible tube mounting step portion 19f is the same as the outer diameter of the lens barrel holding portion 32 covered with the protective tube 35.

  The distal end rigid portion 19 is integrally provided with a pair of fitting protrusions 36a and 36b that protrude from the flexible tube mounting step portion 19f and are disposed at the same position in the cylindrical core direction of the distal end rigid portion. The fitting protrusions 36 a and 36 b are used as a fixing portion for fixing the flexible tube 20 to the distal end hard portion 19.

  As shown in FIG. 7, the flexible tube 20 is formed by connecting a distal end side tube 37, a connecting sleeve 38, and a proximal end side tube 39 in order from the distal end. The distal end side tube 37 and the proximal end side tube 39 are made of, for example, elastomer and have a rubber-like elastic force.

  The connection sleeve 38 is formed in a cylindrical shape from a material having higher rigidity than the distal end side tube 37 and the proximal end side tube 39, for example, ABS resin. The connecting sleeve 38 includes a distal end side connection portion 38a, an intermediate portion 38b, and a proximal end side connection portion 38c in order from the distal end side. In the connection sleeve 38, the distal end side connection portion 38a is covered with the proximal end portion of the distal end side tube 37, and the proximal end side connection portion 38c is covered with the distal end portion of the proximal end side tube 39. As a result, the distal end side tube 37 and the proximal end side tube 39 are connected via the connecting sleeve 38.

  The connecting sleeve 38 has a pair of sliding protrusions 40a and 40b (first sliding engagement portions). The sliding protrusions 40a and 40b are integrally formed so as to protrude from the outer peripheral surface of the intermediate part 38b. The intermediate portion 38b of the connecting sleeve 38 has a larger outer diameter than the distal end side connection portion 38a and the proximal end side connection portion 38c, and the distal end side tube 37 and the proximal end side tube are connected to the distal end side connection portion 38a and the proximal end side connection portion 38c. It is the same as the outer diameter when 39 is covered. The sliding protrusions 40a and 40b are formed at rotationally symmetric positions at a 180 ° pitch, and slide with cam grooves 52a and 52b of the guide sheath 4 described later.

  The distal end surface 37 a of the distal end side tube 37 is formed obliquely with respect to a plane orthogonal to the cylindrical core of the distal end side tube 37. The distal side tube 37 has a distal end surface 37a at a position spaced from the end edge 37b positioned on the distal end side in the cylinder core direction and a position spaced from the end edge 37c positioned on the proximal end side by a predetermined distance. Fixing attachment holes 37d and 37e are formed respectively.

  When the flexible tube mounting step portion 19f of the distal end rigid portion 19 is covered with the distal end side tube 37, the fitting projections 36a and 36b of the distal end rigid portion 19 are respectively inserted into the mounting holes 37d and 37e of the distal end side tube 37. Mated. The base end surface 37 f of the distal end side tube 37 is parallel to a surface orthogonal to the cylindrical core of the distal end side tube 37.

  FIG. 8 shows a process when the flexible tube 20 is assembled to the distal end rigid portion 19. When this step is performed, the observation optical system 22, the light guide 23, and the image guide 24 are first assembled to the distal end rigid portion 19. As shown in FIG. 8A, first, the flexible tube mounting step portion 19f of the distal end rigid portion 19 is gradually covered from the distal end side of the distal end side tube 37. Then, the fitting projection 36a is fitted into the distal mounting hole 37d, and the fitting projection 36b is fitted into the mounting hole 37e by pulling the edge where the proximal mounting hole 37e is located. When the fitting projection part 36b is fitted into the attachment hole 37e, the flexible tube attachment step part 19f is completely covered with the distal end side tube 37, and the distal end side 37a of the distal end side tube 37 is located on the distal end side. The distal end side tube 37 can be fixed to the distal end rigid portion 19 in a state where the end edge 37c positioned on the proximal end side with respect to the positioned end edge 37b is pulled to the same position in the cylinder core direction.

  As shown in FIG. 8B, the distal end side tube 37 is fixed in a state in which the end edge 37c located on the proximal end side is pulled to the same position in the cylinder core direction with respect to the end edge 37b located on the distal end side. Therefore, the bent portion 44 to which the bending edge that bends so that the end edge 37c is located inside and the end edge 37b located outside is formed by the elastic force of the distal end side tube 37. The bent portion 44 is disposed on the proximal end side of the distal end rigid portion 19 and on the distal end side from the center of the distal end side tube 37.

  In addition, the “curved crease” provided in the flexible tube 20 in the present embodiment may be appropriately provided according to the target observation site, but if it is to observe bronchial details as the observation site, 3 mm from the tip. It is preferable that the 20 mm portion bends about 5 ° to 30 °.

  Further, the base end portion of the lens barrel 29 is adhered to the outer peripheral surface of the distal end cover 33 by, for example, an adhesive. As a result, the observation optical system 22 and the image guide 24 are sealed while being kept airtight. Reference numeral 45 (see FIG. 5) denotes a sealed portion between the observation optical system 22 and the image guide 24 sealed by bonding or the like. The sealing portion 45 is housed inside the distal end rigid portion 19 together with the observation optical system 22 and the image guide 24 described above. Since the fitting protrusions 36a and 36b are formed on the flexible tube mounting step 19f of the distal end rigid portion 19, sealing is performed in a state in which the airtightness between the observation optical system 22 and the image guide 24 is maintained. It is located outside the portion 45 in the radial direction of the distal end hard portion 19. Therefore, the flexible tube 20 is covered with the flexible tube mounting step portion 19f, whereby the airtight state is further increased.

  The guide sheath 4 includes an insertion tube 48 through which the insertion portion 7 of the endoscope body 3 is inserted, and a grip portion 49 (see FIG. 1) connected in series to the proximal end portion of the insertion tube 48. As shown in FIG. 8, the insertion tube 48 includes an outer tube 50 formed in a straight tube shape and an inner tube 51 disposed on the distal end side of the inner peripheral surface of the outer tube 50. The outer tube 50 is made of a material having flexibility such as polyurethane resin and higher rigidity than the insertion portion 7.

  The inner tube 51 is formed of a rigid X-ray opaque metal plate, has the same outer diameter as the inner peripheral surface of the outer tube 50, and is slightly larger than the outer peripheral surface excluding the sliding projections 40a and 40b of the insertion portion 7. It is formed on the inner diameter. The inner pipe 51 includes a pair of cam grooves 52a and 52b (second sliding engagement portions), a pair of guide grooves 53a and 53b continuous with the base ends of the cam grooves 52a and 52b, and cam grooves 52a and 52b. Retaining portions 54 a and 54 b (see FIG. 10) located on the distal end side are formed, and the distal end surface is arranged and fitted at the same position as the distal end surface of the outer tube 50. The inner tube 51 can be used as a metal marker under fluoroscopy.

  FIG. 10 is a developed view of the inner pipe 51, and the cam grooves 52 a and 52 b and the guide grooves 53 a and 53 b are viewed from the outside of the inner pipe 51. The cam grooves 52 a and 52 b are inclined grooves formed obliquely with respect to the cylindrical core of the inner tube 51, viewed counterclockwise when the inner tube 51 is viewed from the distal end side, and from the proximal end side to the distal end side of the inner tube 51. It is formed in a direction extending toward. FIG. 10 illustrates a state where the inner tube 51 is cut and expanded at a position indicated by a two-dot chain line A1 and a position indicated by a two-dot chain line A2. Therefore, the cam grooves 52 a and 52 b are continuous at the positions indicated by the two-dot chain lines A 1 and A 2, and are formed over one circumference of the inner tube 51 in the circumferential direction of the inner tube 51.

  As described above, since the pair of sliding projections 40a and 40b are formed at positions that are rotationally symmetric with each other at a pitch of 180 °, the pair of cam grooves 52a and 52b sliding with the sliding projections 40a and 40b. Are also formed at positions that are rotationally symmetric with each other at a pitch of 180 °. Further, the cam grooves 52a and 52b have stoppers 54a and 54b at the ends of the cam grooves 52a and 52b for locking the sliding protrusions 40a and 40b. In order to restrict the sliding projections 40a, 40b from moving toward the distal end side of the inner tube 51 by the retaining portions 54a, 54b, it is possible to restrict the insertion portion 7 from being detached toward the distal end side of the guide sheath 4. it can.

  The guide grooves 53a and 53b are arranged in parallel to the cylindrical core of the inner tube 51 from the base ends of the cam grooves 52a and 52b. The guide grooves 53a and 53b have tapered surfaces 53c and 53d whose width gradually decreases from the base end of the inner tube 51 toward the cam grooves 52a and 52b. As a result, the sliding protrusions 40a and 40b that have passed through the inner peripheral surface of the outer tube 50 are drawn in by the tapered surfaces 53c and 53d of the guide grooves 53a and 53b, and the guide grooves 53a and 53b enter the cam grooves 52a and 52b. enter in. For this reason, the sliding protrusions 40a and 40b smoothly engage with the cam grooves 52a and 52b. In the insertion portion 7, when the sliding projections 40a and 40b slide along the cam grooves 52a and 52b, the connecting sleeve 38 integrated with the sliding projections 40a and 40b rotates around the cylindrical core. The insertion portion 7 can be rotated within the cam grooves 52a and 52b by a rotation angle corresponding to one rotation in which the sliding protrusions 40a and 40b can move, that is, 360 °. The sliding protrusions 40a and 40b are hexagonal shapes that are cut out from a rectangle composed of a plane parallel to and perpendicular to the cylinder core of the inner tube 51 to form an inclined plane parallel to the cam grooves 52a and 52b. It is columnar. Thereby, the sliding protrusions 40a and 40b are easy to slide in the cam grooves 52a and 52b and the guide grooves 53a and 53b.

  The inner tube 51 is formed to be shorter than the distal end side tube 37 of the flexible tube 20, and when the sliding projections 40a and 40b enter the proximal ends of the cam grooves 52a and 52b, the inner side tube 51 is bent. The portion 44 has a length protruding from the distal end of the guide sheath 4. When the cam grooves 52a, 52b and the sliding protrusions 40a, 40b slide, the cam grooves 52a, 52b have a length in the axial direction so that the direction in which the insertion portion 7 bends can be changed at any time. , Longer than the length of the bent portion 44 to which the bent ridge is applied, and shorter than the distance from the base end of the bent portion 44 where the bent ridge starts toward the distal end side to the distal ends of the sliding protrusions 40a and 40b. Has been.

  The guide sheath 4 has such a length that the bent portion 44 of the insertion portion 7 protrudes from the distal end of the outer tube 50, and is formed to have a dimension obtained by subtracting the length of the distal end rigid portion 19 and the bent portion 44 from the entire length of the insertion portion 7. Has been. Thus, when the insertion portion 7 is pushed into the guide sheath 4, the bent portion 44 can be taken out from the distal end of the guide sheath 4.

  As shown in FIG. 5, in a state where the insertion portion 7 is inserted into the guide sheath 4 and the distal end rigid portion 19 is housed near the distal end portion of the guide sheath 4, the rigid straight tubular guide sheath 4. Since the bent portion 44 is accommodated along the inner peripheral surface of the insertion tube 48, the insertion portion 7 together with the guide sheath 4 has a straight tubular shape. When the hand operating portion 8 is pressed from the state shown in FIG. 5 to push the insertion portion 7 toward the distal end side of the guide sheath 4, the sliding projections 40a, 53a, 53b are guided into the guide grooves 53a, 53b by the leading of the tapered surfaces 53c, 53d. 40b enters.

  FIG. 11 shows a state in which the sliding protrusions 40a and 40b have entered the cam grooves 52a and 52b by the guides of the guide grooves 53a and 53b. As described above, the bent portion of the insertion portion 7 extends from the distal end of the guide sheath 4. 44 protrudes. When the bending portion 44 of the insertion portion 7 is taken out from the distal end of the guide sheath 4, one end of the distal end side tube 37 is pulled by the restoring force due to the elasticity of the distal end side tube 37, and the distal end rigid portion is against the cylindrical core of the guide sheath 4. A bent state in which 19 cylindrical cores are inclined is obtained. In this bent state, the inclination angle of the cylindrical core of the distal end rigid portion 19 with respect to the cylindrical core of the guide sheath 4 is preferably set to 5 ° to 30 °.

  As shown in FIG. 12, when the insertion portion 7 is further pushed in from the position where the bent portion 44 of the insertion portion 7 protrudes, the sliding protrusions 40a and 40b move along the cam grooves 52a and 52b as described above. To do. Thereby, since the distal end side tube 37 in a bent state rotates, the direction in which the insertion portion 7 bends changes. 11 shows a state in which the sliding protrusions 40a and 40b are located on the proximal ends of the cam grooves 52a and 52b, and FIG. 12 shows the sliding protrusions 40a and 40b on the distal ends of the cam grooves 52a and 52b. The position is shown.

  The outer diameter of the insertion portion 7 of the present embodiment, that is, the outer diameter excluding the distal end rigid portion 19 and the sliding projections 40a and 40b of the flexible tube 20, is preferably 2.0 mm or less. The guide sheath 4 preferably has the same inner diameter as the outer diameter of the insertion portion 7 or has a slight gap, and the outer diameter is 2.4 mm or less.

  The hand operation unit 8 includes an eyepiece unit 46. In the eyepiece 46, the base end of the image guide 24 is fixed, and an eyepiece optical system (not shown) is accommodated. In the eyepiece optical system, the optical axis is arranged on the same axis as the central axis of the image guide 24. An image of the subject taken in by the observation optical system 22 is emitted from the proximal end of the image guide 24, and the image is enlarged through the eyepiece optical system. Further, the insertion portion 7 is fitted with a bend preventing member 47 formed of a soft member such as a rubber member at an end portion on the hand operating portion 8 side.

  The insertion support apparatus 6 includes a CT image data storage unit 61, a VBS image generation unit 62 that generates a virtual endoscopic image (hereinafter referred to as “VBS image”), and a VBS image storage unit 63. An insertion path setting unit 64, an image processing unit 65, and an image display unit 66. The CT image data storage unit 61 stores, for example, three-dimensional CT image data in a DICOM (Digital Imaging and Communication in Medicine) format generated by a known CT apparatus (not shown) that captures an X-ray tomogram of the patient 9. To do. The VBS image generation unit 62 generates a VBS image from three-dimensional CT image data based on a line-of-sight parameter described later. The insertion / insertion path setting unit 64 sets an insertion path for inserting the insertion unit 7 into the target site of the bronchus 10 from the three-dimensional CT image data. The image processing unit 65 generates an insertion path setting screen for setting an insertion path, and an insertion support screen described later including a VBS image and a plurality of thumbnail VBS images. The image display unit 66 displays the screen generated by the image processing unit 65 on the monitor 67.

  The endoscope system 2 having an insertion navigation function will be briefly described with reference to FIGS. FIG. 12 is a diagram illustrating an example of an insertion path setting screen, and FIG. 13 is a diagram illustrating an example of an insertion support screen. Note that the endoscope system of the present invention does not necessarily have an insertion navigation function. Further, when the insertion path setting screen is displayed to set the insertion path, or the screen or the image is switched, for example, it is performed by an input operation of an input device (not shown).

  As shown in FIG. 13, when performing the insertion navigation, first, for example, information 68A related to the patient 9, an image 68B displaying the insertion route R of the endoscope device 5 and details are not shown on the monitor 67. An insertion path setting screen 68 including the VBS image 68C and the like is displayed. In the image 68B, the insertion path R of the endoscope apparatus 5 up to the target site 70A set by the insertion path setting unit 64 is superimposed on the bronchial image 70 of the patient 9 generated from the three-dimensional CT image data. It is displayed.

  When the endoscope insertion operation is started, the input device switches to the insertion support screen 69. As shown in FIG. 14, the insertion support screen 69 reduces the VBS image display area 69A for displaying the VBS image and the VBS images at all branch portions of the insertion path to the target site and displays them as branch thumbnail VBS images. Branch thumbnail VBS image area 69B and the like.

  FIG. 13 shows an insertion support screen 69 when the target part is reached via four branch parts. That is, the VBS image display area 69A displays the VBS image 71 of the first branch portion of the insertion path, and the branch thumbnail VBS images include the branch thumbnail VBS images 72A to 72D at the four branch sections on the insertion path. Is displayed. In the VBS image 71, a mark 73 is superimposed and displayed on a path hole for proceeding along the insertion path 1.

  The surgeon looks into the eyepiece 46 of the endoscope device 5 and confirms an actual observation image of the bifurcation. FIG. 14 shows an example of an image observed by the endoscope apparatus 5. In FIG. 15, a range surrounded by a solid circle indicates the observation image 74, and a dotted line portion indicates a peripheral portion of the observation image 74. FIG. 15A shows an observation image 74 when the insertion portion 7 is inserted into the bronchus 10 of the patient 9 and the first branch portion is reached. Then, after comparing the VBS image 71 and the actual observation image 74, the distal end rigidity of the insertion portion 7 is adjusted so that the observation image is aligned with the actual path hole 75 corresponding to the path hole indicated by the mark 73 in the VBS image 71. The direction of the part 19 is changed. As described above, the bending portion 44 is bent by taking out the distal end rigid portion 19 and the distal end side tube 37 of the insertion portion 7 from the distal end of the guide sheath 4, and the insertion portion 7 is further pushed into the guide sheath 4 to bend. Since the direction can be varied, the distal end rigid portion 19 can be easily changed to a desired direction. As shown in FIG. 15B, by inserting the insertion portion 7 together with the guide sheath 4 in a state where the observation image 74 is aligned with the path hole 75 corresponding to the path hole indicated by the mark 73, the insertion path 7 is inserted into the insertion path. The insertion portion 7 and the distal end portion of the guide sheath 4 can be fed into the route hole 75 along the route.

  After the surgeon inserts the insertion part 7 and the guide sheath 4 into the path hole 75 along the insertion path indicated by the mark 73 at the first branch part, the VBS image 71 of the insertion support screen 69 is the second branch part. The VBS image is switched to. Then, the endoscope apparatus 5 is operated so that the observation image is aligned with the actual path hole corresponding to the path hole indicated by the mark 73 as in the case of the first branch portion. In this way, the operator inserts the insertion portion 7 and the guide sheath 4 up to the branch portion in the vicinity of the target site 70A without making a mistake in the path hole into which the insertion portion 7 and the guide sheath 4 are to be inserted in each branch portion. can do.

  As described above, since the ultrathin endoscope device 5 having a small outer diameter of the insertion portion 7 and the guide sheath 4 is used, a branch portion having a smaller inner diameter of the bronchus 10 than the conventional one, that is, a portion closer to the extinction of the bronchus 10. The insertion portion 7 and the guide sheath 4 can be inserted until the insertion portion 7 and the guide sheath 4 reach the vicinity of the target portion 70A. Then, after inserting the insertion portion 7 and the guide sheath 4 to the vicinity of the target site 70A, the insertion portion 7 is pulled out from the guide sheath 4 and a treatment instrument such as a biopsy forceps is inserted into the guide sheath 4 instead. . Accordingly, it is possible to perform a treatment such as causing the treatment tool to reach the vicinity of the target site 70A and collecting a tissue sample.

  Further, since the guide sheath 4 is provided with an inner tube 51 that is opaque to X-rays, the guide sheath 4 is inserted to the vicinity of the target site 70A of the bronchus 10 using the insertion navigation function. By confirming the position of the inner tube 51 under fluoroscopy, the distal ends of the guide sheath 4 and the insertion portion 7 can reach the target site. The insertion sheath function is used to insert the guide sheath 4 to the vicinity of the target site 70A of the bronchus 10 and then perform the treatment under fluoroscopy, while confirming the positions of the inner tube 51 and the metal treatment tool. Since the treatment tool can be inserted, the treatment can be performed more reliably.

  Furthermore, since the sliding protrusions 40a and 40b can be rotated by one rotation in the circumferential direction of the inner tube 51 as described above, the distal end rigid portion 19 can be easily changed to a desired direction. Thereby, when the position of the observation image is adjusted to the path hole 75 by changing the bending direction of the insertion portion 7, the position of the observation image can be adjusted only by adjusting the pushing amount of the insertion portion 7 with respect to the guide sheath 4. Therefore, the change of the direction of the distal end rigid portion 19 can be further simplified.

  Further, since the flexible tube 20 includes a pair of sliding projections 40a and 40b, and the guide sheath 4 includes a pair of cam grooves 52a and 52b corresponding to the sliding projections 40a and 40b, the guide sheath 4 includes On the other hand, the insertion part 7 can be rotated stably. In addition, since the end edge 37c located on the proximal end side is fixed to the end position 37b located on the distal end side of the distal end side tube 37 while being pulled to the same position in the cylinder core direction, On the other hand, it is possible to reliably form the bent portion 44 to which the bending wrinkle is imparted with a simple configuration.

  In the above-described embodiment, as the configuration for forming the bent portion 44 provided with the bending wrinkle, the end edge 37c positioned on the proximal end side with respect to the end edge 37b positioned on the distal end side of the distal end side tube 37 is the cylindrical core. However, the present invention is not limited to this, and a flexible tube having a bent portion is formed in advance and fixed to the flexible tube mounting step portion 19f of the distal end rigid portion 19. May be. In addition, the configuration for fixing the flexible tube 20 to the distal end rigid portion 19 is not limited to the fitting between the fitting projections 36a and 36b and the attachment holes 37d and 37e. The flexible tube 20 may be bonded to the attachment step portion 19f.

  In the above embodiment, the first sliding engagement portion includes a pair of sliding protrusions 40a and 40b that are integrally formed to protrude from the outer peripheral surface of the flexible tube 20, and the second sliding engagement portion is Although the structure including the pair of cam grooves 52a and 52b formed on the inner peripheral surface of the guide sheath and sliding with the sliding protrusions 40a and 40b is raised, the present invention is not limited to this. The sliding engagement portion is provided on the outer peripheral surface of the flexible tube 20, and the second sliding engagement portion is disposed on the inner peripheral surface of the guide sheath, slides with the first sliding engagement portion, and is inserted. For example, the first sliding engagement portion is a sliding groove formed in the flexible tube, and the second sliding engagement portion is the guide sheath. It may be a guide protrusion that is arranged on the inner peripheral surface, slides with the sliding groove, and is formed obliquely with respect to the axis of the insertion portion.

  In the above embodiment, the endoscope inserted into the trachea has been described as an example. However, for example, various medical endoscopes such as a colonoscope inserted into the large intestine, and other uses such as industrial applications The present invention can also be applied to an endoscope or the like used for the above.

DESCRIPTION OF SYMBOLS 2 Endoscope system 3 Endoscope main body 4 Guide sheath 5 Endoscope apparatus 6 Insertion support apparatus 7 Insertion part 19 Tip rigid part 20 Flexible tube 22 Observation optical system 24 Image guide 36a, 36b Fitting protrusion part 37d, 37e Mounting hole 40a, 40b Sliding protrusion 50 Outer tube 51 Inner tube 52a, 52b Cam groove 53a, 53b Guide groove

Claims (13)

A distal end rigid portion disposed at the distal end, an observation unit attached to the distal end rigid portion, a flexible tube connected to a proximal end side of the distal end rigid portion and provided with a curl, and an outer peripheral surface of the flexible tube; An endoscope provided with an insertion portion having a provided first sliding engagement portion, and an operation portion attached to a proximal end of the insertion portion;
A guide having a second sliding engagement portion that houses the insertion portion, slides on the inner peripheral surface with the first sliding engagement portion, and is formed obliquely with respect to the axial direction of the insertion portion. An endoscope apparatus comprising a sheath.   The first sliding engagement portion is a sliding projection protruding from the outer peripheral surface of the flexible tube, and the second sliding engagement portion is a cam groove sliding with the sliding projection. The endoscope apparatus according to claim 1, wherein the endoscope apparatus is characterized.   The endoscope apparatus according to claim 2, wherein the guide sheath includes a guide groove having a tapered surface that is continuous with a proximal end of the cam groove and gradually decreases in width toward the cam groove.   The length of the second sliding engagement portion in the axial direction is longer than the portion of the flexible tube to which the bending hook is applied, and the first sliding and the portion where the bending hook starts toward the tip side. The endoscope apparatus according to claim 1, wherein the endoscope apparatus is shorter than a distance from the dynamic engagement portion. The flexible tube includes a pair of the first sliding engagement portions,
The endoscope apparatus according to any one of claims 1 to 4, wherein the guide sheath has a pair of the second sliding engagement portions matched with the first sliding engagement portion. . The flexible tube has a tip surface formed obliquely with respect to a surface orthogonal to the cylindrical core,
The distal rigid portion is formed by pulling an end edge located on the proximal end side to an end position located on the distal end side of the distal end surface of the flexible tube to the same position in the cylinder core direction. The endoscope apparatus according to any one of claims 1 to 5, further comprising a fixing portion that fixes the lens. In the flexible tube, fixing holes are formed in the distal end surface at positions spaced from the edge located on the distal end side by a predetermined distance and at positions spaced from the edge located on the proximal end side by a predetermined distance. And
The fixing portion is a fitting protrusion that protrudes from the outer peripheral surface of the distal end hard portion, is disposed at the same position in the cylindrical core direction of the distal end hard portion, and is fitted to each of the mounting holes. The endoscope apparatus according to claim 6.   The guide sheath includes a retaining portion for locking the sliding protrusion on the distal end side of the cam groove, and the retaining portion restricts the insertion portion from being detached toward the distal end side of the guide sheath. The endoscope apparatus according to any one of claims 1 to 7, wherein the endoscope apparatus is characterized in that:   The observation unit includes the distal end rigid portion, an observation optical system and an image guide attached to the distal end rigid portion, and an outer diameter of the flexible tube excluding the sliding protrusion is 2.0 mm or less. The endoscope apparatus according to any one of claims 1 to 8, wherein the endoscope apparatus is characterized in that: The distal end hard part incorporates a sealing part that seals in a state in which the airtightness between the observation optical system and the image guide is maintained;
The endoscope apparatus according to claim 9, wherein the fixing portion is located outside the sealing portion in a radial direction of the distal end hard portion. The guide sheath includes a straight tubular outer tube, and an inner tube that is disposed on a distal end side of the inner peripheral surface of the outer tube and in which the cam groove is formed,
The endoscope apparatus according to any one of claims 1 to 10, wherein the inner tube is a metal marker made of an X-ray opaque metal.   The endoscope apparatus according to any one of claims 1 to 11, further comprising a treatment tool that is inserted through the guide sheath and is allowed to protrude and retract from a distal end of the guide sheath. The endoscope apparatus according to any one of claims 1 to 12,
Virtual image generating means for generating a virtual endoscopic image of the observation target lumen based on the three-dimensional image data of the observation target, and a plurality of virtual endoscopic images at a branching portion where the observation target lumen branches An endoscope system, comprising: an insertion support apparatus having an image display means for displaying the image.

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