JP2014200336A - Medical apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical apparatus enabling confirmation of the front side of a treatment unit mounted for performing a predetermined treatment within an organism, and attaining an accurate, safe and also rapid procedure.SOLUTION: The medical apparatus includes: a first fiber 110 on the tip end of which a first object lens 111 is installed and to the base end of which a first optical image taken via the first object lens 111 is transmitted; a second fiber 120 on the tip end of which a second object lens 121 is installed and to the base end of which a second optical image taken via the second object lens 121 is transmitted; an image receiving unit 130 structured so that the first optical image and the second optical image can be received; a holding unit 140 which holds the first fiber 110 and the second fiber 120 so that the tip end of the second fiber 120 is arranged nearer to the base end side in an axis direction than the tip end of the first fiber 110; and a treatment unit 160 arranged nearer to the tip end side in an axis direction than the second object lens 121 and mounted so as to perform predetermined treatment within an organism.

Description

  The present invention relates to a medical device.

  In the living body, stenosis may be formed in tubular organs such as lumens and body cavities due to various diseases. As an example, there is known a symptom in which the natural mouth communicating with the nasal cavity is narrowed due to, for example, sinusitis occurring in the sinus. As a treatment for such a stenosis, a surgical procedure in which a lesion is removed with forceps and a drill has been generally used. However, in recent years, a minimally invasive procedure in which a narrowed natural mouth is expanded with a balloon catheter is used. Attention has been paid. For example, Patent Document 1 discloses a method of expanding a natural mouth by operating a balloon catheter under a rigid endoscope. However, in a procedure using a rigid endoscope or the like, when using a treatment instrument such as a balloon catheter, the observation range is narrowed due to the problem that both hands are blocked or the thickness of the endoscope. The problem of end up occurs.

Special table 2008-513125 gazette

  In order to solve the problems as described above, when a camera device is mounted on a medical device such as a balloon catheter, a camera is provided at the tip in order to allow a treatment target site such as a stenosis to be included in the field of view. It is common to be able to see the front side of the balloon. However, when the medical device is configured in this way, positioning cannot be performed while directly observing the balloon, and thus the procedure is performed blindly. Further, since the expanded state cannot be confirmed while the balloon is expanded, it cannot be confirmed whether or not the stenosis portion has been expanded.

  Therefore, when a camera device is mounted on a medical device having a predetermined treatment section such as a balloon, a more accurate, safe, and quick procedure can be achieved if both the treatment section and the front side thereof can be accommodated. Can be realized.

  Accordingly, an object of the present invention is to make it possible to confirm a treatment portion provided for performing a predetermined treatment in a living body and the front side of the treatment portion, thereby realizing an accurate, safe and quick procedure. The object is to provide a medical device.

  The present invention can be achieved by any of the following means (1) to (15).

  (1) A first objective lens is attached to the distal end, a first fiber that transmits a first optical image captured through the first objective lens to a proximal end, and a second objective lens is attached to the distal end. A second fiber that transmits the second optical image captured through the second objective lens to the proximal end, and is disposed on the proximal end side of the first fiber and the second fiber, and is transmitted by the first fiber. An image receiving unit configured to receive the first optical image and the second optical image transmitted by the second fiber, and the distal end of the second fiber closer to the proximal end side in the axial direction than the distal end of the first fiber A holding part for holding the first fiber and the second fiber so as to be arranged, and a structure that can be arranged on the distal end side in the axial direction from the lens surface of the second objective lens; A treatment portion that is provided in order to perform constant of treatment, a medical device having a.

  (2) The medical device according to claim 1, wherein the holding portion includes a long member in which an insertion lumen into which the first fiber and the second fiber can be inserted is formed.

  (3) The angle adjustment unit that adjusts a protrusion angle when at least one of the first fiber and the second fiber inserted through the insertion lumen protrudes from a distal end opening of the insertion lumen. The medical device according to 2).

  (4) In any one of the above (1) to (3), at least one of the first fiber and the second fiber is configured to be rotatable along the outer periphery of the other fiber. The medical device described.

  (5) In any one of the above (1) to (4), at least one of the first fiber and the second fiber is configured to be rotatable around the axis of the one fiber. The medical device described.

  (6) For changing the relative position of the proximal end of the first fiber with respect to the image receiving portion and the relative position of the proximal end of the second fiber with respect to the image receiving portion in a direction intersecting the axis. The medical device according to any one of (1) to (5), further including a position changing unit.

  (7) The first optical image is received on the image receiving unit and the second image on the image receiving unit is disposed between the base end of the first fiber and the base end of the second fiber and the image receiving unit. The medical device according to any one of (1) to (6), further including an image reception switching unit for selectively switching the reception of the optical image.

  (8) The medical device according to any one of (1) to (7), further including an approaching / separating moving unit for moving the first fiber and the second fiber toward and away from the image receiving unit. .

  (9) The medical device according to any one of (1) to (8), wherein the first fiber and the second fiber are configured to be rotatable relative to the image receiving unit.

  (10) a first light guide that emits light toward the front of the first fiber, a second light guide that emits light toward the front of the second fiber, the amount of light of the first light guide, and the The medical device according to any one of (1) to (9), further including: a light amount adjusting unit that can independently adjust a light amount of the second light guide.

  (11) The medical device according to any one of (1) to (10), further including a light guide unit that guides light to the image receiving unit together with the first fiber and the second fiber.

  (12) The treatment section is configured by a balloon that can be expanded and contracted by injecting and discharging fluid, and the balloon is attached to at least one of the holding section, the first fiber, and the second fiber. The medical device according to any one of (1) to (11) above.

  (13) The medical device according to (12), wherein the balloon is provided with an identification unit that can identify an expanded state of the balloon when the balloon is expanded.

  (14) The medical treatment according to any one of (1) to (13), wherein the treatment unit includes a biopsy instrument configured to project from the inside of the holding unit to the outside and collect a biological tissue. apparatus.

  (15) The treatment unit is constituted by an expansion means for expanding a stenosis portion formed in a natural mouth connected to a sinus cavity of a living body, and the medical device is a treatment device used for treatment of sinusitis. The medical device according to any one of (1) to (14) above.

  According to the invention described in (1) above, since the distal end of the second fiber to which the second objective lens is attached is arranged on the proximal end side with respect to the treatment portion, it is transmitted to the image receiving portion via the second fiber. By observing the second optical image, the position of the treatment section can be accurately grasped. In addition, the state of the front side of the medical device can also be confirmed by observing the first optical image transmitted to the image receiving unit via the first fiber. Therefore, it is possible to realize an accurate, safe, and quick procedure by performing various treatments by the treatment unit while confirming each optical image transmitted through each fiber.

  According to the invention described in (2) above, since the holding portion is constituted by the long member in which the insertion lumen into which the first fiber and the second fiber can be inserted is formed, each fiber is disposed in the lumen. It can hold | maintain and it can prevent suitably that damages, such as rubbing and a twist, arise in each fiber.

  According to the invention described in (3) above, since at least one of the fibers inserted through the insertion lumen has the angle adjustment portion that adjusts the projection angle when protruding from the distal end opening of the insertion lumen, each fiber is advanced and retracted. By moving, the observation range of the objective lens included in each fiber can be expanded, and the situation of the front side of the medical device and the treatment unit can be accurately transmitted to the user.

  According to the invention described in (4) above, since at least one of the first fiber and the second fiber is configured to be rotatable along the outer periphery of the other fiber, it depends on the objective lens of each fiber. The observation range can be expanded, and the situation of the front side of the medical device and the treatment unit can be accurately transmitted to the user.

  According to the invention described in (5) above, since at least one of the first fiber and the second fiber is configured to be rotatable around the axis of the one fiber, the orientation of the field of view is changed. It can be changed in any direction such as up and down, left and right, and an environment that is easy for the user to see can be provided according to the usage of the medical device.

  According to the invention described in (6) above, the relative position of the proximal end of the first fiber with respect to the image receiving portion and the relative position of the proximal end of the second fiber with respect to the image receiving portion are determined in a direction intersecting the axis. Since it is possible to change the ratio of each optical image projected on the image receiving unit, or only one optical image can be selectively projected, depending on the usage of the medical device Thus, an image suitable for the user to perform the procedure can be provided.

  According to the invention described in (7) above, it is possible to selectively switch between the reception of the first optical image in the image receiving unit and the reception of the second optical image in the image receiving unit to project only an arbitrary optical image. Therefore, it is possible to provide an image suitable for the user to perform a procedure according to the use application of the medical device.

  According to the invention described in (8) above, it is possible to perform focus adjustment for each fiber by moving the first fiber and the second fiber closer to and away from the image receiving unit, and a clearer optical image can be obtained. It can be projected.

  According to the invention described in (9) above, since the orientation of each optical image can be changed, an image suitable for the user to perform a procedure according to the use application of the medical device is provided. Can do.

  According to the invention described in (10) above, since it is possible to adjust the light amount of each light guide by the light adjustment unit, it is possible to prevent the occurrence of halation, and each optical image with an equal brightness. Since it can be projected, a clearer optical image can be observed through the image receiving unit.

  According to the invention described in (11) above, the light can be directly introduced into the lens barrel by the light guide unit that guides the light to the image receiving unit together with the first fiber and the second fiber. It is possible to suitably prevent the halation from occurring.

  According to the invention described in (12) above, since the treatment portion is configured by a balloon that can be expanded and contracted by injecting and discharging fluid, the medical device is used for an expansion procedure for expanding the stenosis portion by the balloon. It becomes possible.

  According to the invention described in (13) above, since the balloons constituting the treatment section are provided with identification sections that can identify different portions of the balloon when expanded, the balloon expanded state is determined. When confirming, it becomes possible to grasp the expansion amount of the balloon more accurately. In addition, since it is possible to grasp how much the stenosis portion is expanded based on the expansion amount of the balloon, the procedure can be performed more quickly and safely.

  According to the invention described in (14) above, since the operation using the biopsy instrument can be confirmed from the proximal end side through the second fiber, the procedure using the biopsy instrument is accurate and safe, and Can be done quickly.

  According to the invention described in (15) above, the treatment part is constituted by the expansion means for expanding the narrowed part formed in the natural mouth continuous with the sinus cavity of the living body. It is possible to provide a medical device that can act effectively.

1 is an overview diagram showing an overall configuration of a medical device according to a first embodiment of the present invention. It is a fragmentary sectional view for explaining an important section of a medical device concerning a 1st embodiment. It is a figure which illustrates the optical image projected on the image receiving part with which a medical device is provided. It is a figure for demonstrating the modification of the balloon which concerns on 1st Embodiment. It is a figure for demonstrating the modification of the balloon which concerns on 1st Embodiment. It is a figure for demonstrating the other modification of the balloon which concerns on 1st Embodiment, Comprising: It is a figure which expands and shows the side surface of a medical device. It is a figure for demonstrating the other modification of the balloon which concerns on 1st Embodiment, Comprising: It is the arrow figure which looked at the 2nd objective lens from the 4B direction shown to FIG. 4A. It is a fragmentary sectional view showing an important section of a medical device concerning modification 1 of a 1st embodiment. It is a fragmentary sectional view showing an important section of a medical device concerning modification 2 of a 1st embodiment. It is a fragmentary sectional view showing an important section of a medical device concerning modification 3 of a 1st embodiment. It is a fragmentary sectional view showing an important section of a medical device concerning modification 4 of a 1st embodiment. It is a fragmentary sectional view showing an important section of a medical device concerning modification 5 of a 1st embodiment. It is a figure for demonstrating the medical device which concerns on the modification 6 of 1st Embodiment, Comprising: It is a figure which shows the cross section in alignment with the axis orthogonal direction of a medical device. It is a figure for demonstrating the medical device which concerns on the modification 7 of 1st Embodiment, Comprising: It is a figure which shows the cross section which follows the axis orthogonal direction of a medical device. It is a figure for demonstrating the medical device which concerns on the modification 8 of 1st Embodiment, Comprising: It is a figure which expands and shows a lens-barrel. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 8 of 1st Embodiment, Comprising: It is a figure which shows simply the relationship between the position of a lens-barrel, and the position of each fiber. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 8 of 1st Embodiment, Comprising: It is a figure which shows simply the relationship between the position of a lens-barrel, and the position of each fiber. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 9 of 1st Embodiment, Comprising: It is a figure which expands and shows a lens-barrel. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 9 of 1st Embodiment, Comprising: It is a figure which shows a mode that the image received by the image receiving part with which a lens barrel is provided is selected. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 9 of 1st Embodiment, Comprising: It is a figure which shows a mode that the image received by the image receiving part with which a lens barrel is provided is selected. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 10 of 1st Embodiment, Comprising: It is a figure which expands and shows a lens-barrel. It is a figure for demonstrating the medical device which concerns on the modification 11 of 1st Embodiment, Comprising: It is a figure which shows the cross section in alignment with the axis orthogonal direction of a medical device. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 11 of 1st Embodiment, Comprising: It is a figure which shows the mode of a change of the optical image projected on the image receiving part with which a medical device is provided. It is a figure for demonstrating the medical device which concerns on the modification 11 of 1st Embodiment, Comprising: It is a figure which shows the cross section in alignment with the axis orthogonal direction of a medical device. It is a figure for demonstrating the effect | action of the medical device which concerns on the modification 11 of 1st Embodiment, Comprising: It is a figure which shows the mode of a change of the optical image projected on the image receiving part with which a medical device is provided. It is a figure which simplifies and shows the whole structure of the medical device which concerns on 2nd Embodiment of this invention. It is a figure which simplifies and shows the whole structure of the medical device which concerns on 3rd Embodiment of this invention. It is a figure which shows the principal part of the medical device which concerns on 4th Embodiment of this invention. It is a figure which shows the arrangement | positioning relationship of each fiber and objective lens which concern on 4th Embodiment. It is a figure which shows the front end surface of each fiber which concerns on 5th Embodiment. It is a figure which shows the front end surface of each fiber which concerns on 5th Embodiment.

  Embodiments of the present invention will be described below with reference to the drawings. In addition, the dimension ratio of drawing is exaggerated on account of description, and may differ from an actual ratio.

<First Embodiment>
Hereinafter, each embodiment will be described through an example in which the medical device of the present invention is applied to a patient whose stenosis is formed in a natural mouth due to sinusitis. In the description of each figure, the left side in FIG. 2A is referred to as “front end side”, the right side is referred to as “base end side”, and the left-right direction is referred to as “axial direction”.

  As shown in FIG. 1 and FIG. 2A, in brief, the medical device 10 according to the present embodiment has the first objective lens 111 attached to the distal end, and is taken in via the first objective lens 111. A first fiber 110 that transmits an image to the proximal end, and a second objective lens 121 that is attached to the distal end and transmits a second optical image captured through the second objective lens 121 to the proximal end. The first optical image transmitted by the first fiber 110 and the second optical image transmitted by the first fiber 110 are configured to be received on the base end side of the first fiber 110 and the second fiber 120. The first fiber 110 and the second fiber are arranged such that the distal end of the second fiber 120 is arranged closer to the proximal end side in the axial direction than the distal end of the image receiving unit 130 and the first fiber 110. A holding portion 140 that holds the -120, and a treatment portion 160 that is configured to be disposed closer to the distal end side in the axial direction than the second objective lens 121 and that is provided for performing a predetermined treatment in a living body. doing.

  The first fiber 110 is configured by an image fiber that is generally used for transmission of an optical image, but may be configured by, for example, a glass fiber or a plastic fiber. The second fiber 120 can be the same as the first fiber 110.

  As the first objective lens 111 disposed at the tip of the first fiber 110, a general objective lens that collects light and creates an optical image can be used, for example, a glass lens, a resin lens, a refractive index distribution, and the like. Known materials such as lenses, Fresnel lenses, and prisms can be used. Similarly to the first objective lens 111, the second objective lens 121 disposed at the tip of the second fiber 120 can also be configured by a known one.

  The image receiving unit 130 disposed on the proximal end side of the first fiber 110 and the second fiber 120 enlarges the first optical image transmitted by the first fiber 110 and the second optical image transmitted by the second fiber 120, respectively. Or provided to reduce. In the present embodiment, the image receiving unit 130 is configured by an eyepiece used in a general optical photographing apparatus. However, the image receiving unit 130 only needs to be configured so that an optical image transmitted through each of the fibers 110 and 120 can be viewed through an observer's eyes or a known camera device. It can be configured by a lens group including a lens and another optical lens, an optical lens other than an eyepiece, a lens group including an optical lens not including an eyepiece, an optical transmission member such as a fiber, and the like.

  The image receiving unit 130 is housed in a housing 173 having a predetermined shape, and the housing 173 and the image receiving unit 130 constitute a lens barrel 170. Note that a bundling member 175 that facilitates handling of the fibers 110 and 120 can be provided in the lens barrel 170 by bundling the fibers 110 and 120 as illustrated. In the present embodiment, since one image receiving unit 130 is shared with the first and second fibers 110 and 120, the number of parts of the product can be reduced, and the manufacturing can be facilitated and the manufacturing cost can be reduced. Reduction can be achieved.

  The lens barrel 170 only needs to be configured to be able to hold the image receiving unit 130 and the fibers 110 and 120, and can select a hard predetermined member. For example, the lens barrel 170 is formed of a resin material or a metal material. It is preferred that The constituent materials include, for example, various kinds of metals such as polyvinyl chloride, polyethylene, polypropylene, cyclic polyolefin, polystyrene, poly (4-methylpentene-1), polycarbonate, acrylic resin, stainless steel, aluminum, copper, or a copper-based alloy. Examples include various ceramics such as materials, various glasses, alumina, and silica. Moreover, when the image receiving part 130 is comprised with the eyepiece, it is called an eyepiece and can be visually recognized through an observer's eyes or a well-known camera.

  The image receiving unit 130 receives the first optical image transmitted through the first fiber 110 and the second optical image transmitted through the second fiber 120, and allows each image to be enlarged or reduced for visual recognition. Make it possible. When the lens barrel 170 is looked into from the base end side, two optical images A and B can be observed simultaneously as shown in FIG. 2B. In the present embodiment, since the diameter of the first fiber 110 is formed larger than the diameter of the second fiber 120, the first optical image A is projected larger than the second optical image B. Further, as can be understood from FIG. 2B, since the base end portion of the first fiber 110 and the base end portion of the second fiber 120 are arranged apart from each other in a predetermined direction, the positions of the optical images A and B are determined. Will be displayed with the position shifted accordingly.

  As shown in FIG. 2A, in this embodiment, the holding part 140 used to hold the fibers 110 and 120 is a length in which an insertion lumen 141 into which the first fiber 110 and the second fiber 120 can be inserted is formed. The scale member 140 is used. Hereinafter, the holding unit 140 is also referred to as a long member 140.

  Further, in the present embodiment, the first fiber 110 is inserted through the tubular member 150 and inserted into the insertion lumen 141 of the long member 140 while being inserted through the tubular member 150. On the other hand, the second fiber 120 is fixed to the tubular member 150 in a state of being inserted through the insertion lumen 141 so as not to be displaced from a predetermined position as illustrated.

  In order to prevent each member from rotating when the fibers 110 and 120 are inserted into the long member 140 or the tubular member 150, or when the fibers are moved forward and backward in the inserted state, for example, each fiber 110 , 120 and the cross-sectional shape of the insertion lumen 141 can be formed in a non-rotationally symmetric shape. As the non-rotation symmetric shape, for example, an elliptical shape, a polygonal shape, or the like can be adopted. In addition, it can be configured to prevent rotation using magnetic force.

  As the material constituting the long member 140, a soft or hard predetermined member can be selected. For example, it is constituted by a flexible resin material or metal material in consideration of introduction into the living body. It is preferred that The constituent materials include, for example, various kinds of metals such as polyvinyl chloride, polyethylene, polypropylene, cyclic polyolefin, polystyrene, poly (4-methylpentene-1), polycarbonate, acrylic resin, stainless steel, aluminum, copper, or a copper-based alloy. Examples include various ceramics such as materials, various glasses, alumina, and silica.

  As the tubular member 150, for example, a member made of the same material as the holding unit 140 can be used.

  In the present embodiment, the treatment section 160 is configured by a balloon (corresponding to an expansion means) that can be expanded and contracted by injecting and discharging fluid. The balloon 160 is disposed on the outer periphery on the distal end side of the tubular member 150 through which the first fiber 110 is inserted. For this reason, the balloon 160 is attached to the first fiber 110 via the tubular member 150.

  The tubular member 150 can be configured such that it can be bent and deformed, for example, by an operation at hand. For example, a push-pull member such as a string, a wire, or a blade can be attached to the tubular member 150 as in a known flexible endoscope, and the bending operation is performed by operating the push-pull member. can do.

  Since the balloon 160 is disposed on the distal end side of the second objective lens 121, the balloon 160 is accommodated in the observation range of the second objective lens 121. Therefore, it is possible to always observe the balloon 160 via the image receiving unit 130.

  As shown in FIG. 2A, the balloon 160 includes an expansion effective portion 161 that can be expanded in a cylindrical shape, a distal-end-side conical portion 162 that is located on the distal end side of the expansion effective portion 161, and a proximal end relative to the expansion effective portion 161 And a proximal conical portion 163 located on the side. In the expansion of the stenosis N using the balloon 160, the balloon 160 is expanded in a state where the expansion effective part 161 is positioned in the stenosis N, and a pressure is applied to the stenosis N via the expansion effective part 161. Is done. In the drawing, the balloon 160 in a state before expansion deformation is indicated by a two-dot chain line.

  The balloon 160 can be the same as that used for balloon catheters known in the medical field, such as polyethylene, polypropylene, polyolefins such as ethylene-propylene copolymer, polyethylene terephthalate, etc. What was comprised by polyester etc. can be used.

Expansion and contraction of the balloon 160 are performed via a known fluid supply device such as a pump (not shown) and a known fluid tube that communicates the lumen of the balloon 160 and the fluid supply device in a liquid-tight and air-tight manner. it can. The fluid used for expanding the balloon 160 may be a gas or a liquid, and examples thereof include a gas such as helium gas, CO ₂ gas, and O ₂ gas, and a liquid such as physiological saline.

  As shown in FIG. 1, a hand operating unit 180 can be provided at the proximal end of the medical device 10. For example, the hand operation unit 180 can be used to manually operate the bending operation of the tubular member 150, the forward and backward movements of the first fiber 110 and the second fiber 120 in the insertion lumen 141, and other movements and operations of each fiber described later. Provided to enable.

  Further, as shown in FIG. 1, when using the medical device 10, a predetermined adapter 210 to which the first light guide 191 and the second light guide 192 are connected and the adapter 210 via the light source cable 220 are connected. A light source device 230, an image sensor 240 that converts each optical image transmitted through the image receiver 130 into an electrical signal (for example, a CMOS sensor or a CCD sensor equipped with an imaging lens), and an image sensor 240. A signal processing unit 250 that processes an electrical signal transmitted from the optical fiber and a display 260 that displays an optical image transmitted through each of the fibers 110 and 120 as an image can be used in combination.

  As shown in FIG. 2A, the first light guide 191 is inserted through the tubular member 150 and is arranged so that the distal end thereof is positioned near the distal end of the first fiber 110. The second light guide 192 is inserted through the insertion lumen 141 of the elongate member 140 and is arranged so that the distal end thereof is positioned near the distal end of the second light guide 192. Therefore, the tip side of the first fiber 110 is illuminated by the light emitted from the first light guide 191 and the tip side of the second fiber 120 is illuminated by the light emitted from the second light guide 192. A clear optical image formed and transmitted on each of the fibers 110 and 120 via the lenses 111 and 121 is further transmitted to the observation side (the lens surface side viewed through the eyepiece) via the image receiving unit 130. It becomes possible. The light guides 191 and 192 can be bundled and arranged on the adapter 210 side.

  As materials for the light guides 191 and 192, the same materials as those used for the first fiber 110 and the second fiber 120 (for example, glass fiber or plastic fiber) can be used.

  Next, the operation of the medical device 10 according to this embodiment will be described.

  As shown in FIG. 2A, the dilation effective portion 161 of the balloon 160 is positioned in the narrowed portion N formed in the natural mouth O adjacent to the sinuses. At this time, by observing the second optical image formed by the second objective lens 121 and transmitted through the second fiber 120 through the image receiving unit 130, the position of the stenosis N and the position of the balloon 160 are determined. It can be accurately grasped. Therefore, the balloon 160 can be positioned and arranged in the narrowed portion N accurately and quickly.

  In addition, when aligning the balloon 160, the first optical image transmitted through the first fiber 110 disposed on the tip side of the second fiber 120 is observed together with the second optical image. Since the situation in front of the device 10 can also be confirmed, the operation can be performed more quickly and safely.

  When the site to be treated is a sinus, it is necessary to prevent the medical device 10 from excessively entering the sinus existing in front of the natural mouth O for safety. By observing the first optical image transmitted through one fiber 110, it is possible to suitably prevent the excessive entry into the sinuses as described above.

  After the effective expansion portion 161 of the balloon 160 is aligned with a predetermined position of the stenosis N, the balloon 160 is expanded and the stenosis N is expanded. At this time, it is possible to observe the state in which the balloon 160 is expanded and the state in which the narrowed portion N is pushed and expanded through the second optical image reflected on the image receiving unit 130, so that an accurate, safe, and quick procedure can be performed. Can be realized. When the display 260 or the like is used together, the state of the procedure can be confirmed via the display 260.

  As described above, according to the medical device 10 according to the present embodiment, since the distal end of the second fiber 120 to which the second objective lens 121 is attached is disposed on the proximal side with respect to the treatment section 160, the second fiber 120 is removed. By observing the second optical image transmitted to the image receiving unit 130 through the position, the position of the treatment unit 160 can be accurately grasped. In addition, by observing the first optical image transmitted to the image receiving unit 130 via the first fiber 110, it is possible to confirm the state of the medical device 10 on the front side. Therefore, an accurate, safe, and quick procedure can be realized by performing various treatments by the treatment unit 160 while checking each optical image transmitted through each fiber 110 and 120.

  Further, since the holding portion 140 is constituted by the long member 140 in which the insertion lumen 141 through which the first fiber 110 and the second fiber 120 can be inserted is formed, the fibers 110 and 120 are held in the insertion lumen 141. It is possible to suitably prevent the fibers 141 and 142 from being damaged such as rubbing or twisting.

  Further, since the treatment unit 160 is configured by a balloon that can be expanded and contracted by injecting and discharging fluid, the medical device 10 can be used for an expansion procedure for expanding the stenosis N by the balloon.

  Further, since the treatment section 160 is constituted by an expansion means for expanding the stenosis N formed in the natural mouth O connected to the sinus cavity of the living body, a medical device that can effectively act in the treatment of sinusitis 10 can be provided.

  Next, a modification example of the balloon described in the above embodiment will be described. The same members as those described in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted.

  As shown in FIGS. 3A and 3B, the balloon 160 constituting the treatment unit can be provided with an identification unit 310 that can identify the expanded state of the balloon 160 when expanded. When the identification unit 310 is provided in the balloon 160, the expansion amount of the balloon 160 can be grasped more accurately when the second optical image is observed to confirm the expansion state of the balloon 160. In addition, since it is possible to grasp to what extent the stenosis has been expanded based on the expansion amount of the balloon 160, it is possible to perform the procedure more quickly and safely.

  For example, as illustrated in FIG. 3A, the identification unit 310 can be configured by a plurality of linear markers that are attached to different positions in the radial direction. Moreover, as shown to FIG. 3B, it can also comprise by the marker etc. which were attached | subjected to the radial direction of the balloon 160 concentrically. In addition, it is preferable that a color and a pattern are a color and a pattern with which contrast with a biological tissue becomes high so that the boundary with the constriction N can be discriminate | determined clearly, for example. Furthermore, in order to prevent the light irradiated from each light guide 191 and 192 from being reflected and becoming difficult to see, it is preferable that matte coloring for suppressing the reflection of the light is made.

  Next, another modified example of the balloon 160 will be described.

  As shown in FIGS. 4A and 4B, when the treatment portion is configured by the balloon 160, for example, the second objective lens 121 can be accommodated and disposed inside the balloon 160 before being expanded. With this arrangement, it is possible to suitably prevent dirt from adhering to the lens surface of the second objective lens 121 until the balloon 160 is expanded. Therefore, when confirming the expanded state of the balloon 160 and the expanded state of the narrowed portion N, the second optical image can be observed more clearly. Note that when the balloon 160 is expanded, the balloon 160 spreads to the front side and the side side of the second objective lens, so that the balloon 160 can be preferably observed.

  Next, modifications of the first embodiment will be described. About the member already demonstrated in 1st Embodiment mentioned above, the same member is attached | subjected and the description is partially omitted. In the description of each modification, the illustration of the overlapping members is partially omitted, and the description will focus on the changed portions.

<Modification 1>
As shown in FIG. 5, for example, in the medical device 10, the second fiber 120 inserted through the insertion lumen 141 of the long member 140 constituting the holding unit protrudes from the distal end opening 145 of the insertion lumen 141. An angle adjustment unit 320 that adjusts the protrusion angle can be provided. By moving the second fiber 120 forward and backward, the observation range of the second objective lens 121 can be expanded, and the front side of the medical device and the state of the treatment unit can be accurately transmitted to the user.

  In the present modification, the long member 140 for the first fiber and the long member 140 for the second fiber 120 are individually provided so that the second fiber 120 can move forward and backward. In this modification, the first fiber 110 is also configured to be able to move forward and backward independently of the second fiber 120. In addition, the angle at which the first fiber 110 protrudes can be changed.

<Modification 2>
As shown in FIG. 6, for example, the medical device 10 may have a configuration in which a balloon 160 is formed integrally with the first fiber 110. Furthermore, the second fiber 120 can be fixed to the outer surface of the long member 140 without being inserted through the insertion lumen 141. If comprised in this way, it will become possible to comprise the medical device 10 by reducing the diameter overall.

<Modification 3>
As shown in FIG. 7, for example, in the medical device 10, the balloon 160 is integrally formed with the first fiber 110, and the first fiber 110 can move within the insertion lumen 141 of the long member 140 that forms a holding portion. It can be constituted so that. In such a configuration, the balloon 140 can be accommodated in the insertion lumen 141 as necessary, and therefore, it is preferable to prevent the balloon 140 from interfering with a living organ or the like when moving in the living body. Therefore, the medical device 10 can be smoothly moved in the living body.

<Modification 4>
As illustrated in FIG. 8, for example, the treatment unit 160 included in the medical device 10 is configured to be able to protrude from the inside of the long member 140 to the outside and to have a biopsy instrument 330 that collects biological tissue. be able to. Although the configuration of the biopsy instrument 330 is not particularly limited, in the present modification, a curve that is located on a wall surface of a bronchus or the like having a tubular structure and can extract a tissue located at a position away from the medical device 10. Using a shaped tool. Even when a treatment using the biopsy instrument 330 is performed, it is possible to confirm the state of the biopsy instrument 330 from the proximal end side via the second fiber 120 as in the case of using the balloon 160. It is possible to realize an accurate, safe and quick procedure.

<Modification 5>
As illustrated in FIG. 9, the treatment unit 160 included in the medical device 10 may be configured to include a separator 340 configured to scrape biological tissue, for example. By providing the spacer 340, it is possible to prevent the second objective lens 121 from coming into contact with the biological tissue and dirt such as body fluid and blood from being attached to the lens or the tissue being damaged. Even when such a spacer 340 is used, it is possible to confirm the state of the spacer 340 from the proximal end side via the second fiber 120 as in the case of using the balloon 160 or the biopsy instrument 330. Therefore, an accurate, safe, and quick procedure can be realized. In addition, for example, the separator 340 is formed transparently so that the tissue can be easily seen through the separator 340, or the material, color, shape, and the like of the separator 340 are configured in a form in which light is easily diffused. It is possible to improve the lighting effect by a light guide or the like. Further, for example, as shown in the drawing, the holding unit 140 may be a simple fixture (for example, a ring-shaped member) instead of a long member. As the treatment section 160, a catheter device for sucking and supplying fluid can be used.

<Modification 6>
As shown in FIG. 10A, the medical device 10 can be configured such that the second fiber 120 can rotate along the outer periphery of the first fiber 110, for example. If comprised in this way, the observation range of the 2nd objective lens 121 of the 2nd fiber 120 can be expanded, and it will become possible to transmit the front side of medical device 10 and the situation of treatment part 160 to a user correctly. . As a method of configuring the second fiber 120 to be rotatable, for example, a method of making the diameter of the insertion lumen 141 larger than that of the second fiber 120 can be employed. Note that the first fiber 110 may be configured to be rotatable along the outer periphery of the second fiber 120.

<Modification 7>
As shown in FIG. 10B, the medical device 10 can be configured such that, for example, the second fiber 120 can rotate around the axis of the second fiber 120. With this configuration, the direction of the field of view can be changed to any direction such as up and down, left and right, and so the direction desired by the user, particularly when the field of view of the second objective lens 121 is perspective. The viewing direction can be adjusted. Further, for example, by using in combination with the first modification described above, the observation range of the second objective lens 121 can be further expanded. In addition, by forming the cross-sectional shape of the long member 140 as shown in FIG. 10B, for example, the second fiber 120 can be rotatably held along the inner wall of the long member 140. It becomes. Further, the first fiber 110 can be configured to be rotatable around the axis.

<Modification 8>
As shown in FIG. 11A, the medical device 110, for example, determines the relative position of the proximal end of the first fiber 110 with respect to the image receiving unit 130 and the relative position of the proximal end of the second fiber 120 with respect to the image receiving unit 130. A position changing unit 350 for changing in a direction intersecting the axis can be provided.

  The position changing unit 350 may be configured to include an elastic member 351 disposed inside the lens barrel 170, a plate member 352 to which the elastic member 351 is coupled, and a pressing member 353 for pressing the plate member 352. it can. Holes (not shown) through which the base ends of the respective fibers 110 and 120 can be inserted are formed in the plate material 352. The fibers 110 and 120 are held by the plate material 352 through the holes 354. Then, as shown in FIG. 11A, the relative position between the base end position of each of the fibers 110 and 120 and the image receiving unit 130 is changed by moving the plate member 352 in the arrow direction (direction intersecting the axis). It becomes possible.

  FIG. 11B shows an observation image in the image receiving unit 130 before the positions of the fibers 110 and 120 are changed. From this state, the plate material 352 is moved up and down, and the axes of the fibers 110 and 120 are moved with respect to the optical axis of the image receiving unit 130, for example, as shown in FIG. The ratio of the first optical image to be displayed and the second optical image transmitted to the second fiber 120 can be changed, or only one optical image can be selectively displayed. As described above, according to the medical device 10 according to this modification, it is possible to change the ratio of each optical image displayed on the image receiving unit 130 or to selectively display only one of the optical images. Therefore, an image suitable for the user to perform a procedure can be provided according to the use application of the medical device 10.

<Modification 9>
As illustrated in FIG. 12A, the medical device 10 is disposed between the base end of the first fiber 110 and the base end of the second fiber 120 and the image receiving unit 130, and receives the first optical image on the image receiving unit 130. An image receiving switching unit 360 for selectively switching the receiving of the second optical image to the image receiving unit 130 can be configured. If necessary, an optical system can be separately configured before and after the image receiving switching unit 360.

  The image receiving switching unit 360 can be configured by a plate material configured to be movable in a direction crossing the axial direction. A hole 361 is formed in the plate material. For example, when the hole 361 is aligned with the proximal end of the second fiber 120 as shown in FIG. The image is transmitted to the image receiving unit 130. As shown in FIG. 12C, when the hole 361 is aligned with the proximal end of the first fiber 110, the first optical image is transmitted to the image receiving unit 130 via the first fiber 110. In this way, by performing alignment between the hole 361 and the base ends of the fibers 110 and 120, the image reception of the image receiving unit 130 can be switched. Therefore, according to the medical device 10 according to the present modification, only the reception of the first optical image on the image receiving unit 130 and the reception of the second optical image on the image receiving unit 130 are selectively switched so that only an arbitrary optical image is received. Since it becomes possible to project, according to the use application of the medical device 10, the image | video suitable for a user to perform a procedure can be provided.

<Modification 10>
As shown in FIG. 13, the medical device 10 can be configured to have an approaching / separating moving unit 370 for moving the first fiber 110 and the second fiber 120 toward and away from the image receiving unit 130. Although the approaching / separating moving unit 370 is illustrated in a simplified manner, the moving amount of each of the fibers 110 and 120 can be adjusted by a mechanism such as a rack and pinion, for example. As described above, when each of the fibers 110 and 120 can move toward and away from the image receiving unit 130, it is possible to adjust the focus for each of the fibers 110 and 120, so that a clearer optical image can be projected. It becomes. In addition to the method of providing the approaching / separating movement unit 370, for example, a method of incorporating an optical system in the lens barrel 170 and adjusting the focus using this optical system can be adopted as means for adjusting the focus.

<Modification 11>
As illustrated in FIG. 14A, the medical device 10 can be configured such that the first fiber 110 and the second fiber 120 can rotate relative to the image receiving unit 130, for example. For example, a member 380 that assists rotation around the axis can be arranged inside the long member 140 that forms the holding portion so that the fibers 110 and 120 can independently rotate in the same direction. Moreover, the outer peripheral surface of each fiber 110, 120 can be provided with a member for assisting the rotation, or can be provided with an outer shape that can be smoothly rotated. Although not shown in the drawings, in the medical device 10, a member 380 for assisting rotation is configured by a gear, and a gear-shaped groove that can mesh with the gear is formed on the outer surface of each of the fibers 110 and 120.

  As shown in FIG. 14B, when the fibers 110 and 120 are rotated, each forms an optical image in the opposite direction. In this way, by making it possible to change the orientation of each optical image, it is possible to provide an image suitable for the user to perform a procedure according to the intended use of the medical device 10.

  As shown in FIGS. 15A and 15B, for example, the first fiber 110 and the second fiber 120 may be configured to rotate together in the same direction. In this case, the right and left positions of the optical image projected after the rotation are opposite to those before the rotation. In the modified examples shown in FIGS. 15A and 15B, the orientation of each optical image can be changed, so that an image suitable for the user to perform the procedure is provided according to the use application of the medical device 10. It becomes possible. Even when the lens barrel 170 is rotated with respect to the image sensor 240 without rotating the fibers 110 and 120, the optical images can be similarly reversed and projected. As a method of changing the direction of each optical image for display, for example, various signal processing and a method of rotating the monitor itself can be performed in addition to the above method.

Second Embodiment
Next, a medical device according to a second embodiment of the present invention will be described. In addition, the same member number is attached | subjected to the member same as the member demonstrated in 1st Embodiment mentioned above and each modification, and the description is abbreviate | omitted.

  As shown in FIG. 16, the medical device 410 according to the present embodiment irradiates light toward the front of the first fiber 110 and light toward the front of the second fiber 120. The second light guide 412 and the light amount adjusting unit 430 that can independently adjust the light amount of the first light guide 411 and the light amount of the second light guide 412 can be configured. The medical device 410 according to the present embodiment configured as described above has the light adjustment unit 430 that enables the light amounts of the light guides 411 and 412 to be independently adjusted. Different from the device 10.

  Since the light adjustment unit 430 can adjust the light amount of each of the light guides 411 and 412, it is possible to prevent the occurrence of halation. Further, it becomes possible to project each optical image with uniform brightness by weakening the influence of the light of the adjacent light guide. As a method of adjusting the light amount, for example, a method of limiting the amount of light supplied to each of the fibers 110 and 120 by the number of optical fibers that provide light, or the exit end of the light source cable 220 and each of the light guides 411 and 412 is used. It is also possible to adopt a method of adjusting by moving the distance from the base end of the lens closer or away. The first fiber 110 and the second fiber 120 are fixed to each other using a predetermined fixing tool 165.

<Third Embodiment>
Next, a medical device according to a third embodiment of the present invention will be described. In addition, the same member number is attached | subjected to the member same as the member demonstrated in 1st, 2nd embodiment mentioned above, and the description is abbreviate | omitted.

  As illustrated in FIG. 17, the medical device 510 according to the present embodiment includes a light guide unit 520 that guides light to the image receiving unit 130 together with the first fiber 110 and the second fiber 120. In this respect, the medical device according to the first and second embodiments is different.

  The light guide unit 520 can be configured by a light adjusting optical fiber drawn into the lens barrel 170 from a light adjusting unit 530 provided separately from the light adjusting light adjusting unit 430. When each optical image is projected darkly on a monitor or the like, the signal processing unit 250 automatically adjusts the brightness so as to increase the brightness. There is a risk that the image will be projected. Therefore, in the present embodiment, by installing the light guide 520 and directly introducing light into the lens barrel 170, it is possible to increase the brightness and prevent the above-described halation from occurring. Yes. Thus, according to the medical device 510 according to the present embodiment, each optical image can be displayed more clearly. As a result, the brightness can be automatically adjusted regardless of the characteristics of the signal processing unit 250.

<Fourth embodiment>
Next, a medical device according to a fourth embodiment of the present invention will be described. In addition, the same member number is attached | subjected to the member same as the member demonstrated in the 1st-3rd embodiment mentioned above, and the description is abbreviate | omitted.

  As shown in FIGS. 18A and 18B, the medical device 610 can be configured to have a plurality of second objective lenses 121 with respect to one second fiber 120. In the illustrated example, the second objective lenses 121 are arranged at equal intervals along the axis. In the case where a plurality of second objective lenses 121 are used, if they are arranged in the circumferential direction as shown in the figure, the diameter can be reduced and an observation range is ensured over a wide range along the circumferential direction. It becomes possible. Note that the number of the first objective lenses 121 is not limited to the number illustrated, and can be increased or decreased.

<Fifth Embodiment>
As a method of forming the first and second fibers 110 and 120, for example, a method of tearing a single fiber bundle to form two fibers, or a method of polishing a single fiber bundle to change the tip position is used. The first fiber 110 can be formed on the side, and the second fiber 120 can be formed on the base end side. FIG. 19A shows the front end surface of the first and second fibers 110 and 120 formed by polishing the front end side of one fiber bundle, and FIG. 19B shows the first fiber by tearing the front end side. 110, the tip of the second fiber 120 formed is shown. With such a manufacturing procedure, it is possible to provide the first and second fibers 110 and 120 that are preferably used in the medical device described in each embodiment.

  As described above, the medical device according to the present invention has been described through a plurality of embodiments and modifications. However, the present invention can be variously modified based on the description of the scope of claims, and is limited to the described embodiments and modifications. Is not to be done. Further, it is possible to combine the respective embodiments and modifications. For example, in each embodiment, although the form which uses two fibers, a 1st fiber and a 2nd fiber, was shown, the number of fibers is not specifically limited, It can increase suitably.

10, 410, 510, 610 medical device,
110 first fiber,
111 first objective lens,
120 second fiber,
121 second objective lens;
130 Image receiving unit,
140 long member (holding part),
141 insertion lumen,
150 tubular member,
160 balloon (treatment section),
170 lens barrel,
191 1st light guide,
192 Second light guide,
310 identification unit,
320 Angle adjustment unit,
330 biopsy instrument (treatment section),
340 Spacer (treatment part),
350 position change part,
353 pressing member,
360 image receiving switching unit,
370 approaching and moving away part,
411 1st light guide,
412 Second light guide,
430 light adjustment unit,
520 light guide,
530 light control unit,
N stenosis,
O Natural mouth.

Claims (15)

A first fiber having a first objective lens attached to a distal end and transmitting a first optical image captured through the first objective lens to a proximal end;
A second fiber having a second objective lens attached to the distal end and transmitting the second optical image captured through the second objective lens to the proximal end;
An image receiving device arranged on the base end side of the first fiber and the second fiber and configured to receive a first optical image transmitted by the first fiber and a second optical image transmitted by the second fiber. And
A holding portion for holding the first fiber and the second fiber such that the tip of the second fiber is disposed closer to the base end side in the axial direction than the tip of the first fiber;
A medical device having a treatment section configured to be arranged on the distal end side in the axial direction with respect to the second objective lens and provided for performing a predetermined treatment in a living body.   The medical device according to claim 1, wherein the holding portion includes a long member in which an insertion lumen into which the first fiber and the second fiber can be inserted is formed.   The angle adjustment part which adjusts the protrusion angle when at least one fiber of the said 1st fiber and the said 2nd fiber penetrated by the said penetration lumen protrudes from the front-end | tip opening of the said penetration lumen is provided. Medical equipment.   The medical device according to any one of claims 1 to 3, wherein at least one of the first fiber and the second fiber is configured to be rotatable along an outer periphery of the other fiber.   The medical device according to any one of claims 1 to 4, wherein at least one of the first fiber and the second fiber is configured to be rotatable around an axis of the one fiber.   A position changing unit for changing a relative position of the proximal end of the first fiber with respect to the image receiving unit and a relative position of the proximal end of the second fiber with respect to the image receiving unit in a direction intersecting the axis. The medical device according to any one of claims 1 to 5, further comprising:   Between the base end of the first fiber and the base end of the second fiber and the image receiving unit, the image receiving unit receives the first optical image and the image receiving unit receives the second optical image. The medical device according to any one of claims 1 to 6, further comprising an image receiving switching unit for selectively switching the image receiving.   The medical device according to any one of claims 1 to 7, further comprising an approaching / separating moving unit for moving the first fiber and the second fiber toward and away from the image receiving unit.   The medical device according to any one of claims 1 to 8, wherein the first fiber and the second fiber are configured to be rotatable relative to the image receiving unit. A first light guide that emits light toward the front of the first fiber;
A second light guide that emits light toward the front of the second fiber;
The medical device according to any one of claims 1 to 9, further comprising: a light amount adjusting unit capable of independently adjusting a light amount of the first light guide and a light amount of the second light guide.   The medical device according to claim 1, further comprising a light guide unit that guides light to the image receiving unit together with the first fiber and the second fiber. The treatment section is constituted by a balloon that can be expanded and contracted by injecting and discharging fluids,
The medical device according to claim 1, wherein the balloon is attached to at least one of the holding unit, the first fiber, and the second fiber.   The medical device according to claim 12, wherein the balloon is provided with an identification unit that enables identification of an expanded state of the balloon when the balloon is expanded.   The medical device according to any one of claims 1 to 13, wherein the treatment unit includes a biopsy instrument configured to project from the inside of the holding unit to the outside and collect a biological tissue. The treatment part is constituted by an expansion means for expanding a narrowed part formed in a natural mouth connected to a sinus cavity of a living body,
The medical device according to any one of claims 1 to 14, wherein the medical device is a therapeutic device used for treatment of sinusitis.

Images