JP2014033716A - Endoscope, endoscope apparatus, and endoscope system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscope, an endoscope apparatus, and an endoscope system capable of operating two movable parts while improving the operability.SOLUTION: An insertion part 7 of an endoscope includes a distal end hard part 19, a bent part 20, and a rotation mechanism 43. The distal end hard part 19 is fitted with an observation unit. The bent part 20 includes first and second movable cylinders 36 and 37, and a traction wire 38 for bending. The first movable cylinder 36 is continuously connected to the base end side of the distal end hard part 19, and rocks with respect to the second movable cylinder 37 by the traction of the traction wire 38 for bending. The rotation mechanism 43 causes the second movable cylinder 37 to rotate around the cylinder core by the traction of a traction wire 43 for rotation. If an angle knob 54 is rotated anticlockwise, a one-way clutch 61 engages and pulls the traction wire 38 for bending. If it is rotated clockwise, a one-way clutch 67 engages and pulls the traction wire 43 for rotation.

Description

  The present invention relates to an endoscope, an endoscope apparatus, and an endoscope system for remotely operating a movable portion at a distal end portion of an insertion portion.

  In recent years, diagnosis using an endoscope has been actively performed in the medical field. The endoscope includes an insertion portion that is inserted into a body cavity of a patient, and an operation portion that is connected to a proximal end portion of the insertion portion. The operation unit is provided with an operation member such as an angle knob. By operating the operation member, the movable unit provided at the distal end of the insertion unit is pulled and moved by a wire. As a movable part, it is common to provide the bending part for changing the front-end | tip part of an insertion part into a desired direction.

  Japanese Patent Laid-Open No. 2004-228561 provides a zoom mechanism in which a lens system constituting an objective optical system moves as a movable part, and pulls a wire by operating an angle knob to move the lens system to change the focal length. Is described. Patent Document 1 also describes an endoscope provided with a raising base that raises the distal end portion of a treatment instrument such as forceps inserted through the treatment instrument insertion path to the outside of the insertion section as a movable part. Yes.

  On the other hand, recently, an ultra-thin type endoscope having a multi-stage branch such as a bronchus and having an insertion portion with an outer diameter smaller than that of a conventional one so that the tube can be inserted to the end of a thin tube. Proposed. In such an ultra-thin type endoscope, when it is desired to change the course toward the target pipe line at the branching portion, it must be set to a desired bending angle or rotation angle. In the endoscope, even if the insertion portion is rotated on the hand side so as to rotate the distal end of the insertion portion, the torque is not transmitted to the distal end of the insertion portion, and the distal end cannot be rotated in a desired direction. For this reason, in an ultra-thin type endoscope, it is necessary to provide two movable parts, that is, a bending part that bends the distal end of the insertion part and a rotation mechanism that rotates the distal end of the insertion part around the axis.

JP 2003-144376 A

  However, an endoscope having a movable part as described in Patent Document 1 above includes an operation member corresponding to the movable part, and the operation is troublesome when the number of operation members increases according to the movable part, There was a problem in terms of operability. Particularly, in the ultra-thin type endoscope, there is a problem that it takes much time and labor to change the operation member for bending and rotation when changing the path of the insertion portion.

  The present invention has been made in view of the above problems, and provides an endoscope, an endoscope apparatus, and an endoscope system that can operate two movable parts and can improve operability. The purpose is to provide.

  In order to achieve the above object, in the endoscope of the present invention, the distal end rigid portion disposed at the distal end, the observation unit attached to the distal end rigid portion, the flexible tube connected to the proximal end side of the distal end rigid portion, and the distal end An insertion part having first and second movable parts provided integrally with the rigid part, an operation part attached to the proximal end of the insertion part, and a first and second movable part to be pulled and moved. The first and second pull wires, an operation member that is provided in the operation unit and that is rotated, and is built in the operation unit, and is connected to the first pull wire when the operation member is rotated in one rotation direction; and When the connection with the second pulling wire is released and the operation member is rotated in the other rotational direction, the first pulling wire is disconnected from the first pulling wire, and the one-way clutch is connected to the second pulling wire. Features. Thereby, two movable parts can be moved by rotating one operation member.

  The first movable portion is a bent portion that is provided at the proximal end of the distal end hard portion and bends to change the direction of the distal end hard portion, and the second movable portion is for rotating the bent portion around the cylinder core. The first pulling wire is a bending pulling wire that pulls and bends the bent portion, and the second pulling wire is a rotating pulling wire that pulls the rotating mechanism and rotates the bent portion. It is preferable that

  The bent portion includes a first movable cylinder connected to the proximal end side of the distal end rigid portion, and a second movable cylinder that is swingably connected to the first movable cylinder via a connecting portion. The movable cylinder preferably has a fixed portion to which the distal end portion of the bending pulling wire is fixed.

  The rotation mechanism includes a cam groove formed obliquely with respect to the cylindrical core of the second movable cylinder, an engagement member that engages with the cam groove, and an engagement member that engages with the cam groove. It is preferable to provide a coil spring that is biased toward the distal end side.

  The observation unit preferably includes an observation optical system and an image guide attached to the distal end rigid portion, and the distal end rigid portion and the flexible tube preferably have an outer diameter of 2.0 mm or less.

  An endoscope apparatus according to the present invention includes an endoscope and a guide sheath through which an insertion portion is inserted and retracted from a distal end. The guide sheath has a length from which the first movable cylinder projects from the distal end of the guide sheath. It is preferable to be formed. The guide sheath is preferably embedded with a radio-opaque metal marker at the tip. It is preferable to provide a treatment instrument that is inserted through the guide sheath and is allowed to protrude and retract from the distal end of the guide sheath.

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

  In the endoscope of the present invention, the insertion portion includes a treatment instrument insertion passage, and the first movable portion raises the treatment instrument inserted through the treatment instrument insertion passage out of the insertion portion. The second movable part is a direction changing member provided integrally with the raising base, the first pulling wire is a raising wire for raising the raising base, The second pulling wire is preferably a rotating pulling wire that pulls the direction changing member to rotate the raising base in a direction perpendicular to the raising direction.

  The observation unit preferably includes a side-view observation optical system for observing the side-view direction of the insertion portion. Alternatively, the insertion portion is preferably provided with a plurality of ultrasonic transducers arranged at the tip.

  The observation unit includes an objective optical system having a variable power lens and a focusing lens, the first movable part is a variable power mechanism including the variable power lens, and the second movable part includes a focusing lens. The first pulling wire pulls the variable power lens to move in the optical axis direction, and the second pulling wire pulls the focusing lens to move in the optical axis direction. preferable.

  According to the present invention, when the operating member is rotated in one rotation direction, the one-way clutch is connected to the first pulling wire and disconnected from the second pulling wire to pull the first movable part. When the operating member is rotated in the other rotational direction, the one-way clutch is disconnected from the first pulling wire and connected to the second pulling wire to pull the second movable part and move. Therefore, the two movable parts can be operated with one operation member, and the movable of the two movable parts can be switched only by changing the direction of the rotation operation, thereby improving the operability.

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 bending part. It is a perspective view which shows the structure of a traction mechanism. It is explanatory drawing which shows the structure of a bending part and a rotation mechanism. It is a perspective view which shows the structure of a one-way clutch. It is explanatory drawing which shows an operation state when a bending part will be in a bending state. It is explanatory drawing which shows the operation state when a rotation mechanism rotates, after a bending part will be in a bending state. 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. It is the schematic which shows the endoscope apparatus of 2nd Embodiment. It is a perspective view which shows the structure of the insertion part of 2nd Embodiment. It is principal part sectional drawing of the insertion part of 2nd Embodiment. It is a perspective view which shows the structure around a treatment tool raising stand. It is a perspective view which shows the structure of the traction mechanism of 2nd Embodiment. It is a perspective view which shows the modification of 2nd Embodiment applied to the ultrasonic endoscope. It is the schematic which shows the endoscope apparatus of 3rd Embodiment. It is principal part sectional drawing which shows the structure of the insertion part of 3rd Embodiment. It is a perspective view which shows the structure of the traction apparatus of 3rd Embodiment.

[First embodiment]
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 that is a lumen in the body of the patient 9, for example, in a state where the insertion portion 7 is housed in the guide sheath 4. Observable. 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 passage (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 into the treatment instrument insertion path of the endoscope apparatus 12 from the treatment instrument inlet 14A, 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, a bent portion 20 (first movable portion), and a flexible tube 21. 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 order to avoid complication of the drawing, the protection tube 34 and the protection tube 35 are not shown in FIG. 4, and the light guide 23, the image guide 24, and the like are shown only in the tip portion in FIG. .

  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. 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.

  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, a first movable cylinder 36 of the bent portion 20 described later is fixed 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.

  As shown in FIG. 7, the bending portion 20 includes a first movable cylinder 36 and a second movable cylinder 37 and is movable by being pulled by a bending pulling wire 38. The first and second movable cylinders 36 and 37 are cylindrical bodies made of hard synthetic resin or metal. The first and second movable cylinders 36 and 37 are slidably connected by a connecting portion 39. The connecting portion 39 is arranged with its center position aligned with the cylindrical cores of the first and second movable cylinders 36 and 37. The connecting portion 39 includes a pair of connecting pieces 41 formed integrally with the first movable cylinder 36 and a pair of connecting pieces 42 formed integrally with the second movable cylinder 37. A swing hole 41a is formed, and a swing shaft 42a projects from the other connecting piece 42. When the swing shaft 42a enters the swing hole 41a, the first and second movable cylinders 36 and 37 are connected so as to be swingable. The first movable cylinder 36 is set to a swing angle that swings with respect to the second movable cylinder 37 by, for example, 10 ° to 30 °. Further, the second movable cylinder 37 has an axial length longer than that of the first movable cylinder 36 by the amount of a cam groove 37a described later.

  The first movable cylinder 36 is formed with a fixing portion 40 (see FIG. 4) for fixing the bending pulling wire 38. The fixed portion 40 is disposed in the vicinity of the proximal end of the first movable cylinder 36, is a flat portion 40a that is recessed with respect to the outer peripheral surface, and is positioned at the center of the flat portion 40a and has a width that matches the outer diameter of the bending pulling wire And a fitting groove 40b. The bending pulling wire 38 passes through the inner peripheral surfaces of the first and second movable cylinders 36 and 37 and is fitted with the fitting groove 40b at the tip. The distal end portion of the bending pulling wire 38 is fixed to the fixing portion 40 by, for example, soldering or bonding. The bending pulling wire 38 is pulled to the proximal end side by a pulling mechanism 52 described later. As a result, the first movable cylinder 36 swings with respect to the second movable cylinder 37.

  The insertion part 7 includes a rotation mechanism 43 (second movable part) that rotates the second movable cylinder 37 around the cylinder core. The rotation mechanism 43 is provided with a cam groove 37a formed in the second movable cylinder 37, an engagement member 44 that is provided at the distal end portion of the rotation pulling wire 45, and engages with the cam groove 37a, and an engagement member 44. A coil spring 46 and a supporting member 47 are provided, and are movable by being pulled by the rotation pulling wire 45.

  The support member 47 includes a wire moving part 48, a retaining part 49, a spring holding part 50, and a guide hole 51. The wire moving part 48 is formed in a cylindrical shape, and the tip of the rotating pulling wire 45 moves inside. A part of the wire moving portion 48 is cut out, and the engaging member 44 engages with the cam groove 37a through the cutout portion 48a. The retaining portion 49 is located on the proximal end side of the wire moving portion 48, has an outer diameter larger than the outer diameter of the wire moving portion 48 and the inner diameter of the second movable cylinder 37, and matches the inner diameter of the flexible tube 21. Is formed. Thereby, it is controlled that the 2nd movable cylinder 37 detaches to the base end side.

  The spring holding portion 50 is provided so as to protrude from the inner peripheral surface of the retaining portion 49, and a guide hole 51 is formed in the retaining portion 49. The guide hole 51 is a through hole having an inner diameter that is arranged along the axial direction of the second movable cylinder 37 and the support member 47 and that matches the outer diameter of the rotation pulling wire 45. The rotating puller wire 45 is guided in the axial direction of the second movable cylinder 37 and the support member 47 through the coil spring 46 and the guide hole 51. The spring holding portion 50 is formed in a substantially cylindrical shape having a tip end surface larger than the outer diameter of the coil spring 46, and holds the coil spring 46 with the engagement member 44. The engaging member 44 includes a cylindrical portion 44a having an outer diameter larger than that of the coil spring 46, and a columnar engaging pin 44b protruding in the radial direction from the outer peripheral surface of the cylindrical portion 44a. The cylindrical portion 44 a is formed to have the same inner diameter as the outer diameter of the rotating pulling wire 45, and is fixed to the distal end portion of the rotating pulling wire 45.

  The cam groove 37 a is formed with a width that matches the engagement pin 44 b of the engagement member 44. The cam groove 37 a is formed obliquely with respect to the cylinder core of the second movable cylinder 37, viewed clockwise from the distal end side, and from the distal end side to the proximal end side of the second movable cylinder 37. It is formed in the extending direction. When the rotary pulling wire 45 is pulled by a pulling mechanism 52 described later, the engagement pin 44b moves from the distal end side to the proximal end side. At this time, the engaging pin 44b passes through the cam groove 37a. Since the engagement pin 44b moves along the cylinder core direction of the second movable cylinder 37, the engagement pin 44b presses the second movable cylinder 37 when passing through the cam groove 37a. The second movable cylinder 37 pressed along the cam groove 37a rotates counterclockwise as viewed from the tip side.

  As shown in FIGS. 8 and 9, the bending pulling wire 38 and the rotating pulling wire 45 are guided to the hand operating unit 8 through the inside of the flexible tube 21. The hand operating unit 8 is provided with a traction mechanism 52, a case 53 that houses the traction mechanism 52, and an angle knob 54. The angle knob 54 is attached to the case 53 so as to be rotatable about a rotation shaft 54a.

  The traction mechanism 52 includes a transmission gear 55 provided integrally with the rotation shaft 54 a of the angle knob 54, a first gear train 56 disposed between the bending traction wire 38 and the transmission gear 55, and a rotation traction. And a second gear train 57 disposed between the wire 45 and the transmission gear 55. The transmission gear 55 and the gear trains 56 and 57 are supported by the case 53. The number of teeth, the shape, and the like of each gear are not limited to those shown in the drawings, and may be changed as appropriate according to the movement stroke of the bending pulling wire 38 and the rotating pulling wire 45 and the space in the case 53.

  The first gear train 56 includes a traction gear 58 to which the bending traction wire 38 is attached, and intermediate gears 59 and 60. The intermediate gears 59 and 60 are coaxially arranged, the intermediate gear 59 meshes with the traction gear 58, and the intermediate gear 60 meshes with the transmission gear 55. A one-way clutch 61 is provided between the intermediate gears 59 and 60. An attachment pin 58a is integrally provided on the traction gear 58, and the proximal end portion of the bending traction wire 38 is wound around and fixed to the attachment pin 58a.

  Specifically, as shown in FIG. 10, the one-way clutch 61 includes an opening 62 formed in the intermediate gear 59, an engagement portion 63 provided integrally with the intermediate gear 60, and housed in the opening 62. Consists of The engaging portion 63 includes a shaft portion 63a protruding from the center of the intermediate gear 60, a spring portion 63b disposed around the shaft portion 63a, a connecting portion 63c that connects the spring portion 63b and the shaft portion 63a, and a spring. And an engaging claw 63d formed on the outer peripheral surface of the portion 63b. The spring part 63b is formed in an arc shape in which one end part is connected to the connecting part 63c, and an engaging claw 63d is arranged on the other end part. The engaging claw 63d is urged outward by the elasticity of the spring portion 63b and pressed against the opening 62 of the intermediate gear 59. The opening 62 is formed with an engaging claw 62a having a serrated end surface.

  When viewed from the angle knob 54 side, when the intermediate gear 60 rotates counterclockwise, the one-way clutch 61 is engaged with the engaging claws 62a and 63d and the rotational drive is transmitted to the intermediate gear 59. When rotating in the clockwise direction, the inclined surfaces of the engaging claws 62a and 63d slide against each other and the rotational drive is not transmitted to the intermediate gear 60. For this reason, when the angle knob 54 is rotated in the clockwise direction, the transmission gear 55, the intermediate gear 60, the one-way clutch 61, the intermediate gear 59, the traction gear 58, and the bending traction wire 38 are connected to rotate. It is transmitted to the traction gear 58. At this time, when viewed from the angle knob 54 side, the pulling gear 58 rotates clockwise to pull the bending pulling wire 38. On the other hand, when the angle knob 54 is rotated in the counterclockwise direction, the bent pulling wire 38 is not pulled because the rotation is not transmitted to the pulling gear 58 because the connection is released.

  The second gear train 57 includes a traction gear 64 to which the rotation traction wire 45 is attached, and intermediate gears 65 and 66. The intermediate gears 65 and 66 are arranged coaxially with each other, the intermediate gear 65 meshes with the traction gear 64, and the intermediate gear 66 meshes with the transmission gear 55. A one-way clutch 67 is provided between the intermediate gears 65 and 66. The pulling gear 64 is integrally provided with a mounting pin 64a, and the base end portion of the rotating pulling wire 45 is wound around and fixed to the mounting pin 64a.

  The one-way clutch 67 includes an opening 68 formed in the intermediate gear 65 and an engagement portion 69 that is provided integrally with the intermediate gear 66 and is accommodated in the opening 68. The one-way clutch 67 is formed to mesh when rotated in the opposite direction to the one-way clutch 61 of the first gear train 56, and when viewed from the angle knob 54 side, the intermediate gear 66 is counterclockwise. When the intermediate gear 66 rotates clockwise, the engaging claws mesh with each other. The rotational drive is transmitted to the intermediate gear 65. Therefore, when the angle knob 54 is rotated counterclockwise, the transmission gear 55, the intermediate gear 66, the one-way clutch 67, the intermediate gear 65, the traction gear 64, and the rotation traction wire 45 are connected to rotate. Is transmitted to the traction gear 64. At this time, when viewed from the angle knob 54 side, the pulling gear 64 rotates counterclockwise and pulls the rotating pulling wire 45. On the other hand, when the angle knob 54 is rotated clockwise, the rotation pulling wire 45 is not pulled because the connection is released and the rotation drive is not transmitted to the pulling gear 64. Since the traction gears 58 and 64 receive an appropriate frictional force from a bearing portion (not shown), the traction gears 58 and 64 can remain stationary even when the connection is released.

  The flexible tube 21 is covered from above the first and second movable cylinders 36 and 37. The flexible tube 21 is made of, for example, an elastomer and has a rubber-like elastic force. The flexible tube 21 is formed to have the same outer diameter as the outer peripheral surface 19 e of the distal end rigid portion 19, and the distal end covers the flexible tube mounting step portion 19 f and covers the position where it contacts the proximal end of the distal end rigid portion 19. Has been. For this reason, the bent portion 20 is connected to the proximal end side of the distal end rigid portion 19.

  The guide sheath 4 is formed in a straight tube shape, an insertion tube 70 through which the insertion portion 7 of the endoscope body 3 is inserted, a distal end cylindrical portion 71 connected in series to the distal end portion of the insertion tube 70, and the insertion tube 70. And a metal marker 72 embedded in the distal end tubular portion 71 and a gripping portion 73 (see FIG. 1) connected in series to the proximal end portion of the insertion tube 70. The insertion tube 70 is made of, for example, a material having flexibility such as polyurethane resin and higher rigidity than the insertion portion 7. The distal end cylindrical portion 71 is formed of the same resin or the like as the insertion tube 70 and has the same inner diameter and outer diameter as the insertion tube 70.

  At the proximal end portion of the distal end cylindrical portion 71 and the distal end portion of the insertion tube 70, a stepped portion that is recessed by the thickness of the metal marker 72 is formed. The metal marker 72 is made of X-ray opaque metal formed in a cylindrical shape, has the same outer diameter as the insertion tube 70 and the distal end tube portion 71, and has a proximal end portion of the distal end tube portion 71 and a distal end portion of the insertion tube 70. It is fitted on the step. Thereby, the metal marker 72 is embedded so that the outer peripheral surface is continuous with the insertion tube 70 and the distal end tubular portion 71. The grip portion 73 is formed in a cylindrical shape from a hard material such as metal or ABS resin, and the inner diameter thereof is substantially equal to the outer diameter of the insertion tube 70. The grip portion 73 is externally fitted to the proximal end portion of the insertion tube 70.

  The guide sheath 4 has such a length that the first movable cylinder 36 of the insertion portion 7 protrudes from the distal end of the distal end cylindrical portion 71, and the length of the distal end rigid portion 19 and the first movable barrel 36 from the entire length of the insertion portion 7. It is formed in the dimension minus. Accordingly, when the insertion portion 7 is pushed into the guide sheath 4, the first movable cylinder 36 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 insertion portion 7 is accommodated along the inner peripheral surface of the distal end cylindrical portion 71 and the insertion tube 70, the insertion portion 7 together with the guide sheath 4 has a straight tubular shape. At this time, even if the angle knob 54 is rotated clockwise to pull the bending pulling wire 38, the first movable cylinder 36 does not swing due to the rigidity of the guide sheath 4, and the bending portion 20 does not bend. Therefore, the angle knob 54 cannot be rotated clockwise.

  When the hand operating section 8 is pushed into the distal end side of the guide sheath 4 from the state shown in FIG. 5 and the first movable cylinder 36 of the insertion section 7 is taken out from the distal end tubular section 71 of the guide sheath 4, the first movable cylinder 36. Is released from the rigidity of the guide sheath 4, and the bending pulling wire 38 can be pulled. As shown in FIG. 11, when the angle knob 54 is rotated clockwise, the bending pulling wire 38 is connected to the angle knob 54 and the rotating pulling wire 45 is disconnected from the bending knob 38. Can be towed. Thereby, the 1st movable cylinder 36 can rock | fluctuate and the bending part 20 can be made into a bending state.

  After the bent portion 20 is in the bent state, as shown in FIG. 12, when the angle knob 54 is rotated counterclockwise, the angle knob 54 and the bending pulling wire 38 are disconnected, and the rotating pulling wire 45 becomes a connected state, and the pulling wire 45 for rotation can be pulled. The rotating mechanism 43 operates by pulling the rotating pulling wire 45, and the bent portion 20 can be rotated around the cylindrical core to change the direction of the distal rigid portion 19 to a desired direction.

  The outer diameter of the insertion portion 7 of the present embodiment, that is, the outer diameter of the distal end rigid portion 19 and the flexible tube 21 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 operating unit 8 has an eyepiece 74 in addition to the angle knob 54. In the eyepiece 74, 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. The intraluminal image captured 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. In addition, the insertion portion 7 is fitted with a bend preventing member 75 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 (Computed Tomography) image data storage unit 81, a VBS image generation unit 82 that generates a virtual endoscopic image (hereinafter, also referred to as a “VBS image”), and a VBS. An image storage unit 83, an insertion path setting unit 84, an image processing unit 85, and an image display unit 86 are provided. The CT image data storage unit 81 is, for example, a three-dimensional CT in DICOM (Digital Imaging and Communication in Medicine) format generated by a known CT apparatus (not shown) that captures an X-ray tomographic image of the patient 9 to be observed. Stores image data. The VBS image generation unit 82 generates a VBS image from the three-dimensional CT image data. The insertion path setting unit 84 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 85 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 86 causes the monitor 87 to display the screen generated by the image processing unit 85.

  The endoscope system 2 having an insertion navigation function will be briefly described with reference to FIGS. FIG. 13 is a diagram illustrating an example of an insertion path setting screen, and FIG. 14 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 insertion navigation, first, for example, information 88A relating to the patient 9, an image 88B displaying the insertion path R of the endoscope device 5 and details are not shown on the monitor 87. An insertion path setting screen 88 including the VBS image 88C and the like is displayed. In the image 88B, the insertion path R of the endoscope apparatus 5 up to the target site 90A set by the insertion path setting unit 84 is superimposed on the bronchial image 90 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 89. As shown in FIG. 14, the insertion support screen 89 reduces the VBS image display area 89A 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 image area 89B and the like.

  FIG. 14 shows an insertion support screen 89 when the target part is reached via four branch parts. That is, the VBS image 91 of the first branch portion of the insertion path is displayed in the VBS image display area 89A, and the branch thumbnail VBS images 92A to 92D at the four branch sections on the insertion path are used as branch thumbnail VBS images. Is displayed. In the VBS image 91, a mark 93 is superimposed and displayed on a route hole for proceeding along the insertion route 1.

  The surgeon looks into the eyepiece 74 of the endoscope device 5 and confirms an actual observation image of the bifurcation. FIG. 15 shows an example of an image observed by the endoscope device 5. In FIG. 15, a range surrounded by a solid circle indicates the observation image 94, and a dotted line portion indicates a peripheral portion of the observation image 94. FIG. 15A shows an observation image 94 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 91 and the actual observation image 94, the distal end rigidity of the insertion portion 7 is adjusted so that the observation image is aligned with the actual path hole 95 corresponding to the path hole indicated by the mark 93 in the VBS image 91. The direction of the part 19 is changed.

As described above, after the first movable cylinder 36 of the insertion portion 7 protrudes from the distal end of the guide sheath 4, the angle knob 54 is rotated clockwise, and the rotation operation is switched counterclockwise. Since the bending portion 20 can be rotated around the cylinder core and the direction of the distal rigid portion 19 can be changed to a desired direction while the portion 20 is bent, the operability is improved, and the distal rigid portion 19 is improved. Can be easily changed to a desired orientation. Further, in the endoscope apparatus 5, insertion may be difficult even if the distal end rigid portion 19 is slightly displaced with respect to the path hole 95 having a small inner diameter, but only by rotating the angle knob 54. The tip rigid portion 19 having a small outer diameter can be accurately aligned with the path hole 95. Then, as shown in FIG. 15B, the insertion portion 7 is inserted together with the guide sheath 4 in a state where the observation image 94 is aligned with the path hole 95 corresponding to the path hole indicated by the mark 93. The insertion portion 7 and the distal end portion of the guide sheath 4 can be fed into the route hole 95 along the route.

  After the surgeon inserts the insertion section 7 and the guide sheath 4 into the path hole 95 along the insertion path indicated by the mark 93 at the first branch section, the VBS image 91 on the insertion support screen 89 is the second branch section. 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 93 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 90A without making a mistake in the path hole into which the insertion portion 7 and the guide sheath 4 are to be inserted at each branch portion. can do.

  In addition, since the endoscope device 5 having a very small outer diameter of the insertion portion 7 and the guide sheath 4 is used, the insertion portion reaches a branch portion where the inner diameter of the bronchus 10 is smaller than that of the prior art, that is, a portion near the extinction of the bronchus 10. 7 and the guide sheath 4 can be inserted, and the insertion portion 7 and the guide sheath 4 can reach the vicinity of the target portion 90A. Then, after inserting the insertion portion 7 and the guide sheath 4 to the vicinity of the target site 90A, as described above, the insertion portion 7 is pulled out from the guide sheath 4 and the treatment instrument 11 is inserted into the guide sheath 4 instead. Let Thereby, the treatment tool 11 can reach the vicinity of the target site 90A, and a treatment such as collecting a tissue sample can be performed.

  Further, since the guide sheath 4 has a radiopaque metal marker 72 embedded in the distal end thereof, the guide sheath 4 is inserted to the vicinity of the target site 90A of the bronchus 10 using the insertion navigation function. By confirming the position of the metal marker 72 under X-ray fluoroscopy, the guide sheath 4 and the distal end of the insertion portion 7 can reach the target site. After inserting the guide sheath 4 to the vicinity of the target site 90A of the bronchus 10 using the insertion navigation function, the treatment is performed under X-ray fluoroscopy so that the positions of the metal marker and the metal treatment instrument 11 are confirmed. Since the treatment tool 11 can be inserted, the treatment can be performed more reliably.

[Second Embodiment]
In the endoscope apparatus of the first embodiment, the bending portion 20, the rotation mechanism 43 that rotates the bending portion 20, and the insertion portion are provided with the bending pulling wire 38 and the rotation pulling wire 45 that pull these. However, in the endoscope apparatus according to the second embodiment described below, an elevator that raises the treatment tool out of the insertion portion, a direction changing member that is provided integrally with the elevator, and an elevator The configuration includes a pulling wire for raising for pulling the upper table to a raised state, and a rotating pulling wire for pulling the direction changing member to rotate the raising table in a direction perpendicular to the rising direction. In addition, when using the same components as the said 1st Embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted.

  As shown in FIG. 16, the endoscope apparatus 100 of the second embodiment includes an endoscope main body 101 and a treatment instrument 11. The endoscope main body 101 includes an insertion unit 102 that is inserted into a body cavity, a hand operation unit 103 that is connected to the proximal end of the insertion unit 102, and a universal cord 104 that is pulled out from the hand operation unit 103. The insertion portion 102 includes a distal end rigid portion 105 disposed at the distal end, a bending portion 106 connected to a proximal end side of the distal end rigid portion 105, and a plurality of bending pieces, and a flexible bending portion. And a soft portion 107 provided from the base end side of 106 to the connecting portion with the hand operating portion 103.

  The endoscope main body 101 is a side endoscope mainly used as a duodenoscope, and this kind of endoscope is inserted through the oral cavity and inserted from the esophagus through the stomach to the duodenum. It has become. The side-view endoscope is inserted into the common bile duct or the like from the duodenal biliary tract, and a predetermined examination or treatment is performed. For this purpose, the endoscope main body 101 is provided with an insertion path for the treatment instrument 11. As an entrance portion in the insertion path of the treatment instrument 11, the hand operation portion 103 is provided with a treatment instrument entrance 103A.

  As shown in FIGS. 17 and 18, the distal end rigid portion 105 includes a distal end portion main body 108 and a distal end cap 109 that is fitted on the distal end portion main body 108. A flat portion 110 is formed on the side surface portion of the tip cap 109, and an illumination unit 111 and an observation unit 112 are provided on the flat portion 110. An illumination lens is attached to the illumination unit 111, and the exit end of the light guide faces the illumination lens. Further, the observation unit 112 is provided with a side-view observation optical system for observing the side-view direction of the insertion portion, and an image sensor such as a CCD is disposed at the image formation position of the side-view observation optical system. Has been. Since the illumination unit 111 and the observation unit 112 are the same as those used in a conventional side-view endoscope, detailed description thereof is omitted. The universal cord 104 connects a connector 104 a provided at an end to the processor device 113 and the light source device 114. The processor device 113 can display an endoscope image by the endoscope main body 101 on the monitor 115.

  A treatment instrument insertion passage 116 made of a flexible tube is connected to the opening 108f formed in the distal end main body 108. The treatment instrument insertion passage 116 extends from the insertion section 102 through the inside of the hand operation section 103 to the treatment instrument inlet 103A.

  As shown in FIG. 19, the distal end body 108 is attached to the columnar portion 108 a to which the bending portion 106 is connected and the treatment instrument elevator base 117 (first movable portion) that is mounted from the distal end of the columnar portion 108 a. Part 108b. The attachment portion 108b faces the treatment instrument outlet 110a formed in the flat portion 110. When the treatment instrument raising base 117 is in the raising position, the treatment instrument 11 guided in the axial direction of the insertion section 102 by the treatment instrument insertion passage 116 is raised from the treatment instrument outlet 110a to the outside of the insertion section 102. Turn to the direction.

  The treatment instrument raising base 117 has the guide surface 117a of the treatment instrument 11, and is activated by a remote operation from the hand operation unit 103 side and rotated in a direction orthogonal to the raising direction. Can be performed. In addition, the direction orthogonal here includes a substantially orthogonal direction.

  The treatment instrument elevator base 117 is attached to the attachment portion 108b via a ball joint 118. The ball joint 118 includes a spherical portion 117b provided at the proximal end portion of the treatment instrument elevator base 117, and a bearing portion 108c formed on the attachment portion 108b and holding the spherical portion 117b. The guide surface 117a can be changed in direction up and down and left and right around the ball joint 118.

  At the distal end portion of the treatment instrument raising base 117, a raising pull wire 119 for setting the treatment instrument raising base 117 to the raising position and a coil spring 120 are attached. A retaining portion 119a having a large outer diameter is integrally provided at the distal end portion of the raising wire 119 for raising, and a through-hole penetrating from one side surface of the treatment instrument raising base 117 to the other side surface is provided. It is attached to the treatment instrument raising stand 117 in the inserted state. The pulling wire 119 for raising is pulled to the proximal end side of the insertion portion 102 by a pulling mechanism 125 described later. As a result, the treatment instrument elevator base 117 swings toward the outside of the insertion portion 102. The coil spring 120 is arranged so as to extend toward the side opposite to the raising wire 119, and one end is fixed to the treatment instrument raising base 117 and the other end is fixed to the attachment part 108b. The treatment instrument raising base 117 is urged in the direction opposite to the raising direction of 117. Normally, the treatment instrument elevator base 117 is in a retracted position that is housed in the distal end cap 109 by the bias of the coil spring 120, and when the pulling force of the pull-up pull wire 119 is received, the coil spring 120 is biased. Swing to the raised position against.

  The treatment instrument raising base 117 is located between the guide surface 117a and the spherical portion 117b, and a direction changing member 121 (second movable part) protruding to both sides of the treatment instrument raising base 117 is integrally provided. . A rotation pulling wire 123 is attached to one end of the direction changing member 121 via a ball joint 122. The ball joint 122 includes a spherical portion 123 a provided at the tip of the rotating pulling wire 123 and a bearing portion 121 a formed on the direction changing member 121 and holding the spherical portion 123 a. The direction of the tip portion can be freely changed up and down and left and right around the ball joint 122. As a result, the rotating puller wire 123 can pull the one end portion of the direction changing member 121 regardless of the posture of the treatment instrument elevator base 117. The rotation pulling wire 123 is pulled to the proximal end side of the insertion portion 102 by a pulling mechanism 125 described later. Thereby, the treatment instrument raising stand 117 can be rotated in a direction orthogonal to the raising direction.

  In addition, a coil spring 124 disposed toward the distal end side of the insertion portion 102 is attached to the other end portion of the direction changing member 121 at a position opposite to the ball joint 122 with the treatment instrument raising base 117 interposed therebetween. . One end of the coil spring 124 is fixed to the direction changing member 121 and the other end is fixed to the tip cap 109, and biases the direction changing member 121 toward the tip of the insertion portion 102. The coil spring 124 urges the treatment instrument elevator base 117 in a direction opposite to the pulling direction by the rotation pull wire 123, and normally does not urge the direction changing member 121, and keeps the treatment instrument elevator base 117 stationary. The pulling pulling wire 119 and the rotating pulling wire 123 are inserted into the through holes 108d and 108e formed in the cylindrical portion 108a, passed through the inside of the bending portion 106 and the flexible portion 107, and guided to the hand operating portion 103. The

  As shown in FIG. 20, the hand operation unit 103 is provided with a traction mechanism 125, a case 126 that houses the traction mechanism 125, and a raising operation lever member 127. As an operation member provided in the hand operation unit 103, an angle knob 128 (see FIG. 16) for bending operation of the bending unit 106 is provided in addition to the raising operation lever member 127. The raising operation lever member 127 is attached to the case 126 so as to be rotatable about the rotation shaft 127a.

  The traction mechanism 125 includes a transmission gear 129 provided integrally with the rotation shaft 127a, a first gear train 130 disposed between the raising traction wire 119 and the transmission gear 129, and a rotation traction wire 123. And a second gear train 131 disposed between the transmission gear 129 and the transmission gear 129. The transmission gear 129 and the gear trains 130 and 131 are supported by the case 126.

  The first gear train 130 includes a traction gear 132 to which the raising traction wire 119 is attached, and intermediate gears 133 and 134. Intermediate gears 133 and 134 are arranged coaxially with each other, intermediate gear 133 meshes with traction gear 132, and intermediate gear 134 meshes with transmission gear 129. A one-way clutch 61 is provided between the intermediate gears 133 and 134 in the same manner as the intermediate gears 59 and 60 of the first embodiment.

  The second gear train 131 includes a traction gear 135 to which the rotation traction wire 123 is attached, and intermediate gears 136 and 137. Intermediate gears 136 and 137 are arranged coaxially with each other, intermediate gear 136 meshes with traction gear 135, and intermediate gear 137 meshes with transmission gear 129. A one-way clutch 67 is provided between the intermediate gears 136 and 137 in the same manner as the intermediate gears 65 and 66 of the first embodiment.

  When using the endoscope apparatus 100 of the present embodiment and inserting the insertion unit 102 into the body cavity of a patient and performing a treatment while confirming the target site with the monitor 115, first, the treatment unit 103 is provided. The treatment instrument 11 is inserted into the treatment instrument insertion passage 116 from the treatment instrument inlet 103A. At this time, the raising operation lever member 127 is not operated, and the treatment instrument raising stand 117 is stationary at the retracted position. When the distal end portion of the treatment instrument 11 reaches the position of the guide surface 117a of the treatment instrument raising base 117, when the raising operation lever member 127 is rotated clockwise, the transmission gear 129, the intermediate gear 134, the one-way clutch 61, the intermediate gear 133, the traction gear 132, and the raising traction wire 119 are connected, and the raising traction wire 119 is pulled. Accordingly, the treatment instrument raising base 117 can be swung to the raising position, and the treatment instrument 11 can be raised out of the insertion portion 102 from the treatment instrument outlet 110a.

  Further, the transmission gear 129, the intermediate gear 137, the one-way clutch 67, the intermediate gear 136, the traction gear 135, and the rotation traction wire 123 are connected by switching the rotation operation of the raising operation lever member 127 counterclockwise. Thus, the rotary pulling wire 123 can be pulled. Thereby, the treatment instrument raising stand 117 can be rotated in a direction orthogonal to the raising direction. By swinging the treatment instrument raising base 117 in the raising direction and rotating it in the direction orthogonal to the raising direction, the distal end portion of the treatment instrument 11 can be accurately adjusted to the position of the target site. As described above, the raising operation and the rotating operation of the treatment instrument raising stand 117 can be operated by one raising operation lever member 127. Furthermore, it is possible to switch the raising operation and the rotating operation only by changing the direction of the rotation operation of the raising operation lever member 127, and the operability is improved.

  In the second embodiment, the configuration in which the treatment instrument raising base provided in the side endoscope is raised and rotated is illustrated, but the present invention is not limited to this, and the superstructure shown in FIG. The present invention can also be applied to a sonic endoscope. In this case, the distal end rigid portion 141 of the insertion unit 140 of the ultrasonic endoscope has an ultrasonic tomographic image acquisition unit 142 in which a plurality of ultrasonic transducers are arranged in an array, and the ultrasonic tomographic image acquisition unit 142. The treatment instrument outlet 143 located on the end side, the treatment instrument raising base 144 for changing the direction of the treatment instrument 11 from the treatment instrument outlet 143 toward the outside of the insertion portion 140, the observation unit 145, and the illumination unit 146 As a configuration for raising and rotating the treatment instrument raising base 144, a configuration including a pulling wire 119 for raising, a pulling wire 123 for rotation, and a pulling mechanism 125 similar to those of the second embodiment. Is preferred.

[Third Embodiment]
In the first embodiment, the configuration is an ultra-thin type endoscope apparatus provided with the bending part 20 and the rotation mechanism 43 as the movable part. In the endoscope apparatus of the second embodiment, the treatment instrument 11 is inserted into the insertion part. Although the treatment instrument raising base 117 and the direction changing member 121 that are raised outside 102 are provided as movable parts, in the endoscope apparatus according to the third embodiment described below, the magnification changing mechanism and the joint are used as the movable parts. A focusing mechanism is provided. In addition, when using the same component as the said 1st and 2nd embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted.

  As shown in FIG. 22, an endoscope apparatus 150 according to the third embodiment includes an insertion unit 151 that is inserted into a body cavity, a hand operation unit 152 that is connected to the proximal end of the insertion unit 151, and an operation unit 152. And a universal cord 155 extending from the processor device 153 and connected to the light source device 154.

  The insertion portion 151 includes a distal end rigid portion 156, a bending portion 106, and a flexible portion 107 in order from the distal end. An observation unit 157 for in-vivo imaging, an illumination unit, and the like are attached to the distal rigid portion 156. The hand operation unit 16 includes an angle knob 128 for bending operation and a lever member 158 for zooming and focusing operation.

  As shown in FIG. 23, an objective optical system 159 is incorporated in the observation unit 157. The objective optical system 159 includes a fixed lens 160, a variable power lens 161, a focusing lens 162, and a diaphragm 163 in order from the object side. A prism 164 that bends the optical axis PL of the objective optical system 159 by 90 degrees is disposed behind the stop 163, and an image sensor 165 is disposed on the folded optical axis PL. The fixed lens 160 is held at the tip of the lens barrel 166 fixed to the tip rigid portion 156, and exposes the object side surface from the observation window 167 to the outside.

  The observation unit 157 is provided with a zooming mechanism (first movable part) and a focusing mechanism (second movable part). The variable power mechanism includes a variable power lens 161, a lens holder 168 that holds the variable power lens 161, and a guide surface 166 a formed on the inner peripheral surface of the lens barrel 166. The variable power lens 161 held by the lens holder 168 is arranged to be movable in the direction along the optical axis PL with respect to the lens barrel 166 by the guide of the guide surface 166a. The focusing mechanism includes a focusing lens 162, a lens holder 169 that holds the focusing lens 162, and a guide surface 166a. The focusing lens 162 held by the lens holder 169 is provided movably in the direction along the optical axis PL with respect to the lens barrel 166 by the guide of the guide surface 166a.

  The lens holder 168 is integrally provided with a mounting portion 168 a that is disposed through the lens barrel 166. A first pulling wire 170 for pulling the variable magnification lens 161 and moving it in the direction along the optical axis PL is attached to the attachment portion 168a, and a coil spring 171 is attached to the distal end side. The other end side of the coil spring 171 is fixed to the lens barrel 166. The variable power lens 161 is pulled to the proximal end side by the first pulling wire 170 and returns to the distal end side by the biasing force of the coil spring 171 when released from the pulling force of the first pulling wire 170.

  The lens holder 169 is integrally provided with a mounting portion 169a disposed through the lens barrel 166. A second pulling wire 172 for pulling the focusing lens 162 and moving it in the direction along the optical axis PL is attached to the attachment portion 169a, and a coil spring 173 is attached to the distal end side. The other end side of the coil spring 173 is fixed to the lens barrel 166. The variable power lens 161 is pulled to the proximal end side by the second pulling wire 172, and when released from the pulling force of the second pulling wire 172, returns to the distal end side by the bias of the coil spring 173.

  As shown in FIG. 24, the first and second pulling wires 170 and 172 are pulled to the proximal end side of the insertion portion 151 by the pulling mechanism 174. In the pulling mechanism 174, the lever member 158 is attached to the case 126 so as to be rotatable about the rotation shaft 158a.

  The traction mechanism 174 includes a transmission gear 175 provided integrally with the rotation shaft 158 a, a first gear train 176 disposed between the first traction wire 170 and the transmission gear 175, and a second traction wire 172. And a second gear train 177 disposed between the transmission gear 175 and the transmission gear 175. The transmission gear 175 and the gear trains 176 and 177 are supported by the case 126.

  The first gear train 176 includes a traction gear 178 to which the first traction wire 170 is attached, and intermediate gears 179 and 180. Intermediate gears 179 and 180 are arranged coaxially with each other, intermediate gear 179 meshes with traction gear 178, and intermediate gear 180 meshes with transmission gear 175. A one-way clutch 61 is provided between the intermediate gears 179 and 180 in the same manner as the intermediate gears 59 and 60 of the first embodiment.

  The second gear train 177 includes a traction gear 181 to which the second traction wire 172 is attached, and intermediate gears 182 and 183. The intermediate gears 182 and 183 are coaxially arranged, the intermediate gear 182 meshes with the traction gear 181, and the intermediate gear 183 meshes with the transmission gear 175. A one-way clutch 67 is provided between the intermediate gears 182 and 183 in the same manner as the intermediate gears 65 and 66 of the first embodiment.

  With the configuration described above, when the lever member 158 is rotated clockwise, the transmission gear 175, the intermediate gear 180, the one-way clutch 61, the intermediate gear 179, the traction gear 178, and the first traction wire 170 are connected. The state is reached, and the first pulling wire 170 is pulled. By pulling the first pulling wire 170, the variable power lens 161 moves to the base end side along the optical axis PL. Thereby, the focal length of the objective optical system 159 is changed, and the optical magnification is changed.

  Further, by switching the rotation operation of the lever member 158 counterclockwise, the transmission gear 175, the intermediate gear 183, the one-way clutch 67, the intermediate gear 182, the traction gear 181 and the second traction wire 172 are connected, The second puller wire 172 can be pulled. By the pulling of the second pulling wire 172, the focusing lens 162 moves back and forth along the optical axis PL. Thereby, it can adjust so that the focus of the objective optical system 159 may match. As described above, the change of the optical magnification and the focus adjustment can be operated with one operation lever member 158, and the change of the optical magnification and the focus adjustment can be switched only by changing the direction of the rotation operation. This is possible and the operability is improved.

  In each of the above embodiments, a cup-type biopsy forceps is taken as an example of the treatment tool 11, but is not limited thereto, and other treatment tools such as a clip-type forceps, a high-frequency knife, a snare wire, and a syringe may be used. In each of the above embodiments, a medical endoscope has been described as an example. However, the present invention can also be applied to an endoscope used for other uses such as an industrial use.

DESCRIPTION OF SYMBOLS 2 Endoscope system 3 Endoscope main body 4 Guide sheath 5,100,150 Endoscope apparatus 6 Insertion support apparatus 7,102,140,151 Insertion part 11 Treatment tool 19,105,141,156 Tip rigid part 20 Bending Unit 43 Rotating mechanism 117, 144 Treatment instrument raising base 121 Direction changing member 159 Objective optical system 161 Variable magnification lens 162 Focusing lens

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 first and first provided integrally with the distal end rigid portion An insertion part having two movable parts;
An operation unit attached to a proximal end of the insertion unit;
First and second puller wires that pull and move the first and second movable parts;
An operation member provided in the operation unit and operated to rotate;
Built in the operation unit, when the operation member is rotated in one rotation direction, the operation member is connected to the first pull wire and disconnected from the second pull wire, and the operation member is rotated in the other rotation direction. An endoscope comprising: a one-way clutch that disconnects from the first pulling wire and connects to the second pulling wire when rotated to the first position. The first movable portion is a bent portion that is provided at a proximal end of the distal end rigid portion and bends to change the orientation of the distal end rigid portion;
The second movable portion is a rotation mechanism for rotating the bent portion around the cylinder core,
The first pulling wire is a bending pulling wire that pulls and bends the bent portion;
The endoscope according to claim 1, wherein the second pulling wire is a rotating pulling wire that pulls the rotating mechanism to rotate the bent portion. The bent portion includes a first movable cylinder that is connected to the proximal end side of the distal end rigid portion, and a second movable cylinder that is swingably connected to the first movable cylinder via a connecting portion. ,
The endoscope according to claim 2, wherein the first movable cylinder has a fixed portion to which a distal end portion of the bending pulling wire is fixed.   The rotation mechanism includes a cam groove formed obliquely with respect to a cylindrical core of the second movable cylinder, an engagement member provided at a distal end portion of the rotation pulling wire, and engaging the cam groove; The endoscope according to claim 3, further comprising a coil spring that biases the joint member toward the distal end side of the cam.   The observation unit includes an observation optical system and an image guide attached to the distal end rigid portion, and an outer diameter of the distal end rigid portion and the flexible tube is 2.0 mm or less. The endoscope according to any one of 4 to 4. An endoscope according to any one of claims 2 to 5, and a guide sheath through which the insertion part is inserted and retracted from a tip.
The endoscope apparatus according to claim 1, wherein the guide sheath is formed to have a length such that the first movable cylinder protrudes from a distal end of the guide sheath.   The endoscope apparatus according to claim 6, wherein the guide sheath has a metal marker impermeable to X-rays embedded in a distal end portion thereof.   The endoscope apparatus according to claim 6 or 7, further comprising a treatment instrument 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 6 to 8,
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. The insertion portion includes a treatment instrument insertion passage,
The first movable part is a raising base for raising a treatment instrument inserted through a treatment instrument insertion path to the outside of the insertion part,
The second movable part is a direction changing member provided integrally with the raising base,
The first pulling wire is a pulling wire for raising to raise the raising table, and the second pulling wire pulls the direction changing member to raise the raising table. The endoscope according to claim 1, wherein the endoscope is a pulling wire for rotation that is rotated in a direction perpendicular to the endoscope.   The endoscope according to claim 10, wherein the observation unit includes a side-view observation optical system for observing a side-view direction of the insertion portion.   The endoscope according to claim 10, wherein the insertion portion is provided with a plurality of ultrasonic transducers arranged at a distal end. The observation unit includes an objective optical system having a variable power lens and a focusing lens,
The first movable part is a zoom mechanism including the zoom lens,
The second movable part is a focusing mechanism including the focusing lens,
The first puller wire pulls the zoom lens and moves it in the optical axis direction,
The endoscope according to claim 1, wherein the second pulling wire pulls the focusing lens to move in the optical axis direction.

Images