JP2014223107A - Sliding tube for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a sliding tube for endoscope capable of guiding the tip end part of the endoscope to the bile duct easily and manufacturable with relatively low costs.SOLUTION: A sliding tube for endoscope comprises: a tube body 3 with the front and rear end parts thereof opened; and a blocker balloon shaft which is slidably housed axially in the lumen of the tube body. The tube body has a detention balloon 5 provided at the front end part thereof, and also has a lumen 2b for insertion of the endoscope and a lumen 2c for insertion of the blocker balloon shaft formed in the lumen thereof. The blocker balloon shaft has a shaft tube 20, and the shaft tube has a blocker balloon 21 provided at the front end part thereof. On a surface of the blocker balloon, anti-slippage protruding ridge portions 25 are provided as components which bring the tip end part of the endoscope inserted through the lumen for insertion of the endoscope into contact with to guide the tip end of the endoscope to the destination site.

Description

  The present invention relates to a sliding tube for an endoscope, and more particularly to a technique that is widely used as an endoscope insertion assisting tool that secures an access route to a place where it is difficult to insert an endoscope. It is.

  For patients with bile duct stones and bile duct cancer, cholangioscopic examination for confirming residual stones and diagnosing the progression of cancer has become an important diagnostic method. However, direct observation of the bile duct with an endoscope inserts an oral biliaryscope (child scope) through the forceps hole of the side endoscope (parent scope), so two light sources, the side endoscope and the oral biliaryscope, are required. As a result, the number of facilities installed is limited due to the high cost of equipment.

  Therefore, recently, a small-diameter nasal endoscope inserted from the nasal cavity has been introduced into many facilities, and an increasing number of facilities attempt direct observation of the bile duct using this nasal endoscope. However, since the bile duct is anatomically located perpendicular to the wall of the duodenum, the insertion force is applied in the direction of the descending leg of the duodenum even if the distal end of the endoscope is hooked on the bile duct. The distal end portion of the endoscope escapes to the descending leg of the duodenum, and it was very difficult to insert the distal end portion of the endoscope into the bile duct.

  As a countermeasure, a method has been announced in which a single balloon catheter for occlusion is installed in the direction of the descending leg of the duodenum near the bile duct to prevent the endoscope from escaping to the descending leg of the duodenum. However, in this method, after the tip of the endoscope comes into contact with the surface of the blocker balloon provided at the front end of the shaft tube of the blocker balloon shaft, it slides on the surface and is successfully inserted into the tip of the endoscope. It can be considered that the force of direction cannot be applied. Therefore, there is a problem that the burden on the patient increases because the time for the examination itself becomes longer.

  In view of the situation as described above, the inventors have started to develop a technique that can easily guide and insert the distal end portion of the endoscope into the bile duct, and have completed the present invention. As patent documents that are considered to be related, there are JP-A-62-222623 (Patent Document 1) and JP-A-2011-2224047 (Patent Document 2).

  Patent Document 1 discloses an endoscope insertion aid made of a cylindrical body, an opening opening on a side wall at a distal end portion of the cylindrical body, and expansion and contraction adjacent to the distal end side from the opening. A balloon for supplying and discharging fluid to and from the balloon, and supplying the fluid to the balloon through the passage to inflate and fix the cylindrical body in the body cavity to guide the endoscope To do. Patent Document 2 discloses a first over which has an endoscope having a bendable portion at a distal end portion, an opening portion at a distal end portion, and a side opening opening in a side wall of the distal end portion, and the endoscope is inserted. An endoscopic device comprising a tube and a second overtube having an opening at the tip and having the first overtube inserted therein, wherein the first overtube is an opening of the second overtube The first overtube has a first balloon that can be inflated and deflated on the outer peripheral surface on the tip side from the side mouth, The second overtube has a second balloon that can be inflated and deflated on an outer peripheral surface of a distal end portion, and the endoscope has a side mouth portion of the first overtube from an opening portion of the second overtube. Bending the bendable part in a state where is exposed It made protruding from the side opening portion, in which the endoscope can be easily inserted into the Vater's papilla. However, since both of the balloons and the first balloon are similar to the balloons mentioned in the background art, they have the same problems.

JP-A-62-26233 JP 2011-224047 A

  Accordingly, in view of the conventional problems as described above, the present invention provides an endoscope sliding tube that can easily guide the distal end portion of an endoscope to a bile duct and can be made relatively inexpensive. With the goal.

  In order to solve the above-mentioned problems, the invention according to claim 1 assists the insertion of an endoscope into a site that is difficult to insert with an endoscope alone, and includes a tube main body having open front and rear ends, and the tube main body. A blocker balloon shaft that is slidably housed in the axial direction in the lumen of the tube, the tube body is provided with an indwelling balloon at the front end, and an endoscope insertion lumen in the lumen A lumen for inserting a blocker balloon shaft is formed, and the blocker balloon shaft has a shaft tube, and a sliding tube for an endoscope in which a blocker balloon is provided at a front end portion of the shaft tube. A portion for guiding the distal end portion of the endoscope inserted from the endoscope insertion lumen and then guiding it to the target site Wherein the is provided.

  The invention according to claim 2 is the invention according to claim 1, wherein a plurality of members for guiding are provided on the surface of the blocker balloon so as to extend in a radial direction from the attachment proximal end side to the intermediate portion. It is a slip prevention ridge. According to a third aspect of the present invention, in the first or second aspect, a housing portion for housing the contracted blocker balloon is provided in the lumen of the front end portion of the tube body.

  According to a fourth aspect of the present invention, in the third aspect, the endoscope insertion lumen and the blocker balloon shaft insertion lumen of the tube body are formed by a partition wall that is divided into two cavities along the length direction. In addition, the front end lumen without the partition wall is used as a storage portion.

  According to a fifth aspect of the present invention, in any one of the first to fourth aspects, the inner surfaces of the endoscope insertion lumen and the blocker balloon shaft insertion lumen are provided with a hydrophilic coating.

  According to a sixth aspect of the present invention, in any one of the first to fifth aspects, a guide wire insertion lumen having front and rear ends opened is formed along the entire length of the shaft tube of the blocker balloon shaft.

  The present invention is as described above. According to the first aspect of the present invention, in the sliding tube for an endoscope, the distal end of the endoscope inserted from the endoscope insertion lumen into the surface of the blocker balloon. Since a member for guiding the part to the target site after contact is provided, the distal end portion of the endoscope can be easily guided to the target site, for example, the bile duct by this guide member. In particular, by inflating the blocker balloon in the descending leg of the duodenum, it is possible to prevent the endoscope from touching the blocker balloon and escaping to the descending leg of the duodenum. There is an excellent effect that the burden can be reduced.

  According to the second aspect of the present invention, a plurality of members for guiding are provided on the surface of the blocker balloon so as to extend in the radial direction from the attachment base end side to the intermediate portion, and to prevent slipping. Since it is a ridge, it is possible to quickly cope with any orientation of the distal end portion of the inserted endoscope.

  According to the third aspect of the present invention, since the storage portion for storing the contracted blocker balloon is provided in the lumen of the front end portion of the tube body, the blocker balloon in the contracted state when not in use is compactly stored. It becomes possible to store in.

  According to the invention described in claim 4, the endoscope insertion lumen and the blocker balloon shaft insertion lumen of the tube main body are formed by partition walls that are divided into two cavities along the length direction, Since the front end lumen without the partition wall is used as the storage section, the related configuration of the storage section and both lumens can be simplified and a structure that can exhibit functionality can be achieved.

  According to the fifth aspect of the present invention, since the inner surfaces of the endoscope insertion lumen and the blocker balloon shaft insertion lumen are coated with a hydrophilic coating, the endoscope and the blocker balloon inserted into these lumens are provided. It becomes possible to always smoothly slide the shaft. According to the sixth aspect of the present invention, since the guide wire insertion lumen with the front and rear ends opened is formed in the entire length of the shaft tube of the blocker balloon shaft, the blocker balloon shaft using the guide wire is formed. Insertion is also possible.

It is the front view which abbreviate | omitted a part of the length direction of the sliding tube for endoscopes which concerns on one embodiment of this invention. It is the front view which abbreviate | omitted a part of the length direction of the blocker balloon shaft. It is an expansion front sectional view of the tip side of a sliding tube. It is a front sectional view of the rear end side of the sliding tube. It is a front sectional view showing a state in which the tip portion of the shaft tube of the blocker balloon shaft is protruded from the front end opening of the tube body of the sliding tube by contracting the blocker balloon. It is sectional drawing same as the above, (A) is sectional drawing which follows the AA line of FIG. 5, (B) is sectional drawing which follows the BB line of FIG. 5, (C) is CC line of FIG. FIG. (A) is a front view which shows the blocker balloon of a shaft tube, (B) is the right view. It is a right view corresponding to (B) of Drawing 7 showing the modification of the blocker balloon of a shaft tube. It is a right view corresponding to FIG. 7 (B) showing another modification of the blocker balloon of the shaft tube. It is a front view corresponding to (A) of Drawing 7 showing another modification of a blocker balloon of a shaft tube. It is a front view which shows the state which both balloons of the sliding tube and the shaft tube expanded. It is the anatomical outline figure of the bile duct vicinity mentioned as an operation example using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube. It is a perspective view which shows the state which contacted the surface of the balloon in the state in which the front-end | tip part of the endoscope was bent, and was induced | guided | derived to the slip-down prevention convex strip provided in this surface. It is a schematic diagram explaining a process until it inserts and observes an endoscope in a bile duct using a sliding tube.

  Hereinafter, an endoscopic sliding tube according to an embodiment of the present invention will be described with reference to the drawings.

  1-3, 1 is a sliding tube for an endoscope made of a material suitable for a living body such as silicone rubber, and this sliding tube 1 has a lumen 2 with its front and rear ends open over its entire length. Is provided with a tube main body 3 that can be guided to the duodenum, and a blocker balloon shaft 4 that is slidably accommodated in the lumen 2 of the tube main body.

  An indwelling balloon 5 for indwelling and fixing the tube body to the duodenum is provided at the front end of the tube body 3 of the sliding tube 1. The lumen 2 of the tube main body 3 from the position slightly behind the rear end to the rear end from the position where the indwelling balloon 5 is provided is partitioned vertically by the partition wall 6 as shown in FIGS. That is, the lumen from the front end of the partition wall 6 to the front end opening of the tube body 2 is a large cavity in which the partition wall 6 is not formed as shown in FIG. 6 (A). A later-described blocker balloon provided on the balloon shaft 4 is a balloon storage portion 2a that can be stored in a contracted state (see FIG. 3). The lumen from the front end of the partition wall 6 to a predetermined position on the rear end side of the tube body 2 is two cavities having a substantially semicircular cross-sectional shape as shown in FIG. The inner lumen up to the rear end of the tube main body 2 has two large and small cavities having a perfect circular cross-sectional shape as shown in FIG. Of the two cavities, the lower large cavity is formed in the endoscope insertion main lumen 2b for inserting an endoscope (not shown), and the upper small cavity is formed in the sub-lumen 2c for insertion of the blocker balloon shaft 4. ing. 6A to 6C, reference numeral 7 denotes an air supply lumen for inflating the indwelling balloon 5.

  As shown in FIG. 4, the rear end of the tube body 3 is branched from an endoscope insertion main lumen 2b, and a water injection connector 10 for dampening a hydrophilic coating described later of the main lumen 2b, an indwelling balloon. A connector 11 with an air supply one-way valve for inflating 5 is provided. Further, a water injection connector 13 is provided at the rear end portion of the tube main body 3 to branch from the sub-lumen 2c for inserting the blocker balloon shaft 4 and wet the hydrophilic coating of the sub-bloumen, and the front end portion. Is provided with a fixture (adapter) 14 for fixing the blocker balloon shaft 4 so as not to slide freely. Reference numeral 15 denotes a connector branched from the lumen of the water injection connector 13, and a tip cap 16 for closing the water injection port is provided at the tip thereof.

  On the other hand, the blocker balloon shaft 4 has a shaft tube 20 having a small diameter and a predetermined length as shown in FIGS. A blocker balloon 21 is provided at the front end of the shaft tube 20 to block the duodenum in the descending leg direction and guide the endoscope to the bile duct. Further, the shaft tube 20 has a double lumen structure in which two lumens whose front and rear ends are opened in the entire length direction (axial direction) (see FIG. 3), and a main lumen having a large diameter among them. Is a lumen 22 for inserting a guide wire, and a sub-lumen having a small diameter is an air supply lumen 23 for inflating the blocker balloon 21.

  On the surface of the blocker balloon 21, as shown in FIG. 7, a plurality of slip-preventing ridges 25 serving as an endoscope guiding member are provided from the base end portion on the rear end side of the shaft tube 20 toward the intermediate portion. (5 in the figure) are provided radially. Therefore, when the endoscope is guided to the bile duct, the distal end portion of the endoscope comes into contact with the anti-slip protrusion 25 on the surface of the blocker balloon 21 so that the distal end portion does not slip on the balloon surface. Therefore, the inductivity of the endoscope to the bile duct is improved as compared with a simple spherical balloon without such slip-preventing protrusions. The reason why a plurality of slip-preventing ridges 25 are provided in a radial manner is that the tip of the endoscope can more easily come into contact. As shown in the drawing, it is preferable to provide a plurality of slip-preventing ridges 25 in a radial manner, but it is not always necessary to provide a plurality, and one may be provided. Further, the shape is arbitrary as long as the shape is a protrusion. Since the placement position of the blocker balloon 21 with anti-slip ridges that can easily guide the distal end portion of the endoscope to the bile duct differs depending on the patient, the shaft tube 20 is movable independently of the main body tube 3 as shown in FIG. It is possible to make it.

  FIG. 8 shows a modification of the blocker balloon. In this example, three slip-off preventing ridges 25a are radially provided on the surface of the blocker balloon 21a from the base end portion toward the intermediate portion. FIG. 9 also shows another modification of the blocker balloon. In this example, ten slip-preventing protrusions 25b are provided radially on the surface of the blocker balloon 21b from the base end portion toward the intermediate portion. The shape of the slip-preventing ridges 25a and 25b is the same as that of the slip-preventing ridge 25 described above. FIG. 10 shows another example of another blocker balloon. In this example, the slip-preventing protrusion 25c is not simply a flat plate like the slip-preventing protrusions 25a and 25b, but is recessed on the short side. While being formed in a curved shape, a part of the base end side is notched, and a plurality of blocks are provided radially on the surface of the blocker balloon 21c from the base end portion toward the intermediate portion. Any of the examples given here can be expected to have the same effect as the anti-sliding protrusion 25. In particular, in the case of 25c, it is easy to hook and capture the distal end portion of the endoscope with the curved concave inner surface, and it is possible to expect the effect that the guidance can be performed quickly and smoothly.

  As shown in FIG. 4, a guide wire insertion port portion 27 that serves as a guide wire insertion port (not shown) and a blocker balloon 21 are connected to the rear end portion of the blocker balloon shaft 4. An air supply stopcock 28 for inflating the blocker balloon is provided in communication with the air supply lumen 23 for inflating.

  Endoscopes are inserted orally into the biliary tract, but generally the distance to the biliary tract varies somewhat depending on the patient. Therefore, if the sliding tube 1 is longer than the distance to the biliary tract, The sliding tube 1 may protrude long. If the amount of protrusion from the mouth is large, the tube body 3 may be loosened, which may reduce the operability and responsiveness of the endoscope. Therefore, the insertion position of the endoscope is as much as possible in the sliding tube 1. The vicinity of the insertion portion is preferable. Therefore, as shown in FIG. 4, a side hole 30 for inserting an endoscope is provided on the side wall of the tube body 3 near the connector 10 so as to communicate with the main lumen 2b. By inserting the endoscope from the side hole 30, the insertion position of the endoscope can be brought close to the insertion portion of the sliding tube 1 without adjusting the overall length of the sliding tube 1. And responsiveness can be kept constant.

  The inner surface of the main lumen 2b and the sub-lumen 2c of the tube body 3 is provided with a hydrophilic coating so that the endoscope and the tube tube 20 of the blocker balloon shaft can easily slide.

  Next, with reference to FIGS. 12 to 21, the operation of the above-described endoscope sliding tube will be described until the endoscope is inserted into the bile duct and observed using the endoscope sliding tube 1. . FIG. 12 is an anatomical outline view of the vicinity of the bile duct cited as an example of operation using the endoscope sliding tube 1 of this embodiment.

  In use, first, the endoscope sliding tube 1 in a state in which the blocker balloon 21 is housed in a balloon housing portion 2a provided in the front end portion of the tube body 3 in a contracted state as shown in FIG. Insert into the duodenal lumen through the mouth (FIG. 13). At this time, the indwelling balloon 5 provided at the front end of the tube body 3 is also in a contracted state. Then, the indwelling balloon 5 is inflated by the air injected from the air feeding lumen 7 in the vicinity of the ascending portion of the duodenum, and the tube body 3 is indwelled and fixed (FIG. 14).

  Next, the blocker balloon shaft 4 with slip-preventing protruding ridges is extended to the anal side ahead of the fatter papilla in the lower duodenum (FIG. 15). When the blocker balloon shaft 4 is extended, the shaft tube 20 is made of a relatively soft material, so that the blocker balloon shaft 4 may sway left and right around the axial direction. Therefore, a guide wire (not shown) is passed in advance through the guide wire insertion lumen 22 of the shaft tube 20 and inserted into the target position with the waist strengthened, and the tip is aligned, and then injected from the air supply lumen 23. The blocker balloon 21 is inflated with air to close the duodenal lumen (FIG. 16).

  Thus, if the said guide wire is used, the blocker balloon shaft 4 can be extended | stretched smoothly. In addition, for example, a guide wire previously passed through the guide wire insertion lumen 22 may be advanced to the target position, and then the shaft tube 20 may be advanced along the guide wire. In the above description, air is injected to inflate both the indwelling balloon 5 and the blocker balloon 21. However, not only a gas such as air but also a liquid such as physiological saline may be used.

  Next, the endoscope 40 inserted from the distal end through the side hole 30 for inserting the endoscope into the main lumen 2b of the tube main body 3 is sequentially inserted and pushed out from the tube main body 3 (FIG. 17). Then, after the distal end portion is bent and inserted into the fatter papilla, it is pushed into the bile duct inlet (FIG. 18). At this time, the bent distal end portion of the endoscope 40 comes into contact with the blocker balloon 21 inflated in the descending portion of the duodenum, and is guided by the anti-sliding protrusion 25 provided on the surface of the balloon and is not pushed into the anal side. Into the bile duct (FIG. 19).

  That is, as shown in detail in FIG. 20, when the tip of the endoscope 40 is bent and contacts the surface of the balloon, conventionally, it slides on the surface and falls downward, and then the bile duct is successfully removed. Although it could not be inserted into the balloon, the tip of the bent anti-skid ridge 25 hits the anti-skid ridge 25 and its position is defined and the direction of travel is guided. Torque is transmitted to the endoscope 40 and can be easily inserted into the bile duct.

  The endoscope 40 having the distal end portion inserted into the bile duct then performs bile duct observation with the distal end portion reaching a predetermined position (FIG. 21).

  When the bile duct observation is finished, the endoscope 40 is retracted and removed from the bile duct. Then, the tube body 3 is again put into the main lumen 2b and pulled out, while the blocker balloon 21 and the indwelling balloon 5 are deflated by being deflated, and in the blocker balloon shaft 4 provided with the blocker balloon 21, the shaft tube 20 The blocker balloon 21 is again housed in the balloon housing portion 2a by retracting. Thereafter, the sliding tube 1 is retracted from the inserted duodenal lumen and pulled out. As a result, the entire sliding tube 1 is pulled out from the mouth to the original preoperative state.

  As described above, when the sliding tube 1 is used, the tip end portion of the endoscope 40 can be easily guided to the bile duct by the slip-preventing protrusion 25 provided on the surface of the blocker balloon 21. Thus, the tip of the endoscope 40 can be easily inserted into the bile duct without slipping off the surface of the balloon.

  Moreover, in this embodiment, as described above, the blocker balloon 21 of the endoscope sliding tube 1 is narrowed so that it can be stored in the balloon storage portion 2a provided at the front end portion of the tube body 3. There is no fear that the distal end of the shaft tube of the blocker balloon 21 will come into contact with the tissue or the like and it will be difficult to intubate the tube body 3 into the body cavity.

  The above embodiment is merely a preferred example, and it goes without saying that the design and the like of the details can be arbitrarily changed and modified within the scope of the present invention. For example, the bile duct is shown as the insertion destination of the distal end portion of the endoscope, but the present invention can be applied not only to the bile duct but also to any target site of the internal organ officer. Moreover, the shape and structure of the tube main body 3 and the blocker balloon shaft 4 which are main components including the slip-preventing protrusion 25 as the guide member are merely shown as examples, and other designs may be used.

DESCRIPTION OF SYMBOLS 1 Endoscopic sliding tube 2 Lumen 2a Balloon storage part 2b Endoscope insertion main lumen 2c Blocker balloon shaft insertion sub-lumen 3 Tube body 4 Blocker balloon shaft 5 Indwelling balloon 6 Partition wall 20 Shaft tube 21 Blocker Balloon 22 Lumen for insertion of guide wire 23 Lumen for air supply 25, 25a, 25b, 25c Anti-slip projection (guide member)
30 Endoscopic side hole 40 Endoscope

Claims (6)

  A tube body with an open front and rear end and a blocker balloon shaft that is slidably housed in the lumen of the tube body in order to assist the insertion of the endoscope into a site that is difficult to insert with an endoscope alone. The tube body is provided with an indwelling balloon at the front end, and an endoscope insertion lumen and the blocker balloon shaft insertion lumen are formed in the lumen, and the blocker balloon shaft is a shaft. An endoscope sliding tube having a tube and having a blocker balloon provided at a front end portion of the shaft tube, the distal end portion of the endoscope being inserted into the surface of the blocker balloon from the endoscope insertion lumen A slide for an endoscope, characterized in that a member for guiding to a target site after contact is provided Ring tube.   The inner member according to claim 1, wherein the guide member is a plurality of slip-preventing ridges provided on the surface of the blocker balloon from the base end side of the blocker balloon to the intermediate portion and extending in the radial direction. Endoscopic sliding tube.   The sliding tube for an endoscope according to claim 1 or 2, wherein a housing portion for housing the blocker balloon in a contracted state is provided in a front end portion lumen of the tube body.   The endoscope insertion lumen and the blocker balloon shaft insertion lumen of the tube body are formed by a partition wall that divides into two cavities along the length direction, and accommodates a front end lumen without the partition wall. The sliding tube for an endoscope according to claim 3, which is a part.   The sliding tube for an endoscope according to any one of claims 1 to 4, wherein a hydrophilic coating is provided on inner surfaces of the endoscope insertion lumen and the blocker balloon shaft insertion lumen.   The sliding tube for an endoscope according to any one of claims 1 to 5, wherein a guide wire insertion lumen having open front and rear ends is formed along a length of the shaft tube of the blocker balloon shaft.